Article

The relationship between childbirth self-efficacy and aspects of wellbeing, birth interventions and birth outcomes

June 2015
Midwifery 31(10)

DOI:10.1016/j.midw.2015.05.005

Source
PubMed

Authors:

Ing-Marie Carlsson

Halmstad University

Kristina Ziegert

Halmstad University

Eva Nissen

Karolinska Institutet

this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors. a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records. data were recruited from antenatal health-care clinics in Halland, Sweden. a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42. five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States. results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy. this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sense of coherence in pregnancy: a systematic review of the literature.

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Jan 2023

Background Pregnancy is acknowledged as a time of physiological, social, and psychological challenges that may compromise a pregnant woman’s quality of life. Healthcare advocates have proposed a paradigm shift in maternity services towards a framework that includes the promotion and generation of health such as Antonovsky’s framework of salutogenesis. Central to salutogenesis are general resistance resources (GRRs) (i.e., assets and resources available to an individual) and sense of coherence (SOC) (i.e., a measure of their ability to mobilize their GRRs and manage physical, mental and social stressors). To begin to explore the role of SOC in pregnancy care, we critically analyzed, synthesized and summarized studies with quantitative measures of SOC during pregnancy. Methods A systematic review of the literature was performed using PubMed & Medline, Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsychInfo between 1997 to 2022. Inclusion criteria for review were manuscripts: (1) of peer-reviewed primary investigation reports, (2) measuring SOC among pregnant women and (3) written in the English language. Manuscripts excluded were: (1) qualitative studies, (2) abstracts from conference proceedings and (3) dissertations from a Master or PhD degree. Quality assessment used the NIH National Heart, Lung, and Blood Institute Study Quality Assessment Tools. Our systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Results Our systematic review found 49 studies (i.e., prospective (n=29) and cross-sectional (n=17) cohorts) meeting inclusion criteria. Pregnant women (93% of subjects; n=27, 186) completed primarily the SOC-13 instrument along with 67 other patient reported outcomes (PROs) of mental and social health domains. Physical health measures were lacking. Overall, a low SOC score was associated with compromised health outcomes during pregnancy, labor and birth. Cause and effect inferences between measures of SOC and PROs remain largely unexplored. Conclusion The findings of this review are that low SOC is associated with poor prenatal health outcomes. Maternity care should focus on a more comprehensive approach that addresses not only morbidities and risks but also protective and stress resisting factors that promote health such as increasing a pregnant woman’s sense of coherence.

A new theoretical model for personalized Midwifery Care towards the intra-extra hospital Autonomy

Article

Full-text available

Apr 2020

ABSTRACT Although the importance of general obstetric support in childbirth has been widely recognized for its effect on overall outcome, there is no evidence in the literature of a model for detecting women's ante-intrapartum needs in order to provide personalized care. In this paper, "The predictive model for the quality of delivery and related obstetric interventions" is proposed. Keywords Personalized ante-intra-partum obstetric assistance, theoretical model.

A Psychoeducational Intervention in Prenatal Classes: Positive Effects on Anxiety, Self-Efficacy, and Temporal Focus in Birth Attendants

Article

Full-text available

Jun 2022
Int J Environ Res Publ Health

Background: Previous studies have reported associations between high maternal anxiety, temporal perceptions during pregnancy, and a poor sense of self-efficacy. One type of anxiety expecting mothers experience is associated with childbirth, which previous studies have shown can be reduced by antenatal training. Recent contributions have pointed out that current prenatal courses, while providing important and useful knowledge, do not devote sufficient content to the mental health of the parturient and to the psychological issues that can arise before and after the birth. Methods: In total, 80 pregnant women were provided with a special prepartum course in which ample space was devoted to topics such as maternal mental health, parenting skills and couple relationship, relaxation techniques, and assertiveness. Perception of threat, state anxiety, temporal focus, needs and expectations, and self-efficacy were assessed by comparing this psychoeducational intervention group with a traditional antenatal course group (n = 80), and a control group (n = 80). Two-way mixed ANOVAS (3 × 2) were performed for each dependent variable considered, including the time variable (pre-course-post-course) as a factor within the participants and the group variable as a factor between the subjects. Results: The psychoeducational intervention actually induced significant and positive changes primarily on four dimensions: state anxiety, perceived self-efficacy, the need for information, and reassurance of the pregnant women who participated in this trial. Conclusions: The study suggests improving the quality of prenatal classes by paying particular attention to the content and communication used within the group, in order to gratify at the highest level, the need for information, reassurance, and sharing that characterize the parturient's request for support. The evidence collected recommends further replicating the intervention protocol described in order to improve the psychophysical well-being of women in a delicate moment such as pregnancy and preparation for childbirth, but especially in terms of the prevention and containment of the risks of psychological distress that currently affect a significant number of women after childbirth.

Factors Affecting Primiparous Pregnant Women’s Prenatal Attachment Levels, Childbirth Self-Efficacy Beliefs, and Labor Worry Levels

Article

Full-text available

Mar 2022
Clin Nurs Res

This study aimed to identify the factors affecting primiparous pregnant women’s prenatal attachment levels, childbirth self-efficacy beliefs, and labor worry levels. This cross-sectional study was conducted with 351 pregnant women. The data were collected by using a Personal Information Form, the Prenatal Attachment Inventory, the Oxford Worries about Labour Scale, and the Childbirth Self-Efficacy Inventory. The mean Prenatal Attachment Inventory, Oxford Worries About Labour Scale and Childbirth Self-Efficacy Inventory scores of the participants were 40.53 ± 10.32, 21.82 ± 6.8, and 201.35 ± 23.21, respectively. The data obtained in the study showed that the care offered in the preconception period affected the participating pregnant women’s prenatal attachment, labor worry, and childbirth self-efficacy levels. With individualized preconception care provided by health personnel, not only will awareness be increased but also women will be able to have a more positive pregnancy and labor experience.

Evaluating the Effectiveness of Childbirth Preparation Courses on Women’s Self-Efficacy among Ultra-Orthodox Jewish Religious Women in Israel

Article

Full-text available

Jun 2021

Background: This study examined the effectiveness of a birth preparation course on coping with childbirth among primigravid ultra-orthodox Jewish women in Israel. Methods: In total, 130 ultra-orthodox 25–35-week primigravid women were divided into a study (n = 100, participated in birth preparation courses) and a control (n = 30, did not participate in the courses) group. A questionnaire was delivered three times: T1—before the course/delivery, T2—two–three days after delivery, and T3—a month after delivery. Results: At T3, self-efficacy among the study group was higher than in the control group. Differences in self-efficacy were found over time regardless of the group (F(2,246) = 12.83, p < 0.001), as a time–group interaction effect (F(2,246) = 10.20, p < 0.01). Self-efficacy in the study group (Mean, M = 3.40, Standard deviation, SD = 0.63 at T1) dropped to M = 3.06, SD = 0.76 at T2 and rose to M = 3.34, SD = 0.64 at T3. In the control group, self-efficacy (M = 3.53, SD = 0.56 at T1) dropped to M = 3.26, SD = 0.63 at T2 and to M = 2.95, SD = 0.76 at T3. Discussion: The childbirth preparation course was found to be effective in raising self-efficacy among primigravid ultra-orthodox religious women when compared to the control group.

Reproducing fear: the effect of birth stories on nulligravid women’s birth preferences

Article

Full-text available

Jun 2021

Objective Preference for caesarean birth is associated with higher fear and lower self-efficacy for vaginal birth. Vicarious experience is a strong factor influencing self-efficacy in nulligravid women, and is increasingly accessible via digital and general media. This study assessed the effect of exposure to different birth stories on nulligravid women’s childbirth preferences and the factors mediating these effects. Methods Nulligravid women ( N = 426) were randomly allocated to one of four conditions exposing them to written birth stories. Stories varied by type of birth (vaginal/caesarean) and storyteller evaluation (positive/negative) in a 2 × 2 design. Childbirth preference, fear of labour and vaginal birth, and self-efficacy for vaginal birth were measured before and after exposure via a two-way between groups analysis of covariance. Hierarchical regression models were used to determine the mediating effects of change in childbirth fear and childbirth self-efficacy. Results Variations in type of birth and storyteller evaluation significantly influenced childbirth preferences ( F (1, 421) = 44.78, p < 0.001). The effect of vaginal birth stories on preference was significantly mediated by fear of labour and vaginal birth and self-efficacy. Effects of exposure to caesarean birth stories were not explained by changes in fear or self-efficacy. Conclusions Childbirth preferences in nulligravid women can be significantly influenced by vicarious experiences. For stories about vaginal birth, the influence of birth stories on women’s fear and self-efficacy expectancy are partly responsible for this influence. The findings highlight the importance of monitoring bias in vicarious experiences, and may inform novel strategies to promote healthy childbirth.

Brazilian women’s use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study

Article

Full-text available

Apr 2021
PLOS ONE

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women’s experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women’s needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Pregnant women's knowledge and use of evidence-based practices during labor and childbirth after participating in a health education intervention -Senses of Birth

Thesis

Feb 2020

Luísa M. M. Fernandes

Background: Senses of Birth (SoB) is a health education intervention in Brazil that addresses reproductive rights, the benefits and risks of normal birth and cesarean, and use of evidence-based practices (EBP) during labor and childbirth, aiming to reduce unnecessary cesareans in the country. This mixed-method study had three objectives: 1) evaluate the impact of the SoB intervention on pregnant women’s perceived knowledge about normal birth, cesarean, and use of EBP in childbirth; 2) identify socio-demographic factors, obstetric characteristics, and aspects of women’s perceived knowledge that influence women’s use of EBP; and 3) analyze the outcomes, barriers and facilitators/strategies to use EBP described by women and understand their correlation with socio-demographic factors, obstetric characteristics and women’s perceived knowledge. Method: 1,287 pregnant women answered a post-test survey, immediately after their visit to the exhibition, between March 2015 and March 2016, in four different cities. 555 women answered an online follow-up survey after giving birth. Quantitative analyses were performed, including T-tests, ANOVA, logistic and linear regression. A qualitative analysis using discourse analysis was also performed. To further understand women’s use of EBP experience, a triangulation of methods was used. Results: The mean score (MS) of perceived knowledge after the intervention was higher than the mean score before experiencing the SoB for all three knowledge domains: Normal Birth (MS Before= 3.71 x MS After= 4.49), Cesarean (MS Before= 3.54 x MS After= 4.26) and EBPs (MS Before= 3.14 x MS After= 4.14). The results suggest that the SoB intervention was more effective for low income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49- 4.09 for normal birth), women with private prenatal care (OR 2.42, 95% CI: 1.59- 3.66 for normal birth), women experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for normal birth; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and women in their first or second trimester at the time of the intervention (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for normal birth; OR 1.85, 95% CI: 1.40-2.41 for cesarean). In this study, the majority of women used intrapartum EBPs, with the exception of the doula support (26%). Using the intrapartum EBPs was associated with high mean score of knowledge before the intervention; giving birth in a public hospital (p ≤ 0.05); and having a vaginal birth (p ≤ 0.05). Some practices were also associated with socioeconomic characteristics: women among the lower-income range (2 to < 5 MW) were less likely to use a birth plan (35.1%, p ≤ 0.05) and have midwife care (40.1%, p ≤ 0.01) compared to women with more than 10 MW; being a black woman was correlated with not using a birth plan (59.3%, p ≤ 0.01), and not having doula support (56.7%, p ≤ 0.01); and women who had more than 13 years of formal education were associated with use of a birth plan (83.3%, p ≤ 0.01), freedom of mobility during labor (84.3%, p ≤ 0.05) and freedom of choice of position at delivery (83.3%, p ≤ 0.01). Midwife care (95.9%, p ≤ 0.05) and doula support (97.9%, p ≤ 0.05) were also associated with women who believed they were able to have a normal birth after participating in the SoB intervention. Women who answered the open-ended questions on the follow-up survey and were included into the qualitative analysis perceived an increase in knowledge for EBP Knowledge domain after participating in the SoB intervention. Positive outcomes were described related to the use of EBPs, such as satisfaction and respect of their choices, while negative outcomes were referred by women who did not use the practices. Barriers identified by women mainly referred to low quality of care, especially no woman-centered care to support and incentivize/promote the use of EBPs, while facilitators reported reinforced the need to implement EBPs protocols at hospitals but also the importance of individualized care and respect, reinforcing the “acolhimento” practices. Conclusion: The study showed opportunities to increase knowledge among Brazilian pregnant women for the three knowledge domains, and a need to focus the discussion on how to achieve a positive experience of birth using EBP. This study corroborates previous findings that Brazilian women have restricted access to intrapartum EBPs, and although recent policies have improved the offers, there are still systemic barriers that make it difficult for women to achieve a positive childbirth experience. Increased perceptions of knowledge about normal birth, cesarean and EBP gave the women a chance to critically reflect upon the maternal care scenario in Brazil and advocate for their choices, desires, and rights. Nonetheless, it is clear that health education is an essential element to increase the use of WHO and MS recommended practices. However, it cannot be used isolated from systemic changes that overcome barriers identified by women, including co-responsibility with the changes by hospitals/institutions and health professionals. The intervention gains relevance considering the lack of evidence of the efficacy of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries prioritizing women. Therefore, this study can guide policy decisions and program implementation to improve maternal health care by explicitly considering women's voices and experiences. As long as we continue to value only authoritative knowledge and not involve the women in their own health care decisions, the health system will continue to be organized outside of their priorities. Keywords: Maternal Health, Childbirth, Health Education, Cesarean Section, Evidence-based Medicine, Women’s Knowledge

Große Angst vor der Geburt bei schwangeren Frauen in Deutschland: Erfahrungen und Orientierungen in Bezug auf die Schwangerenbetreuung und die Geburts- vorbereitung -eine rekonstruktive Studie Zusammenfassung Hintergrund: Da Schwangere mit großer Angst vor der Geburt (gAvG)/ Tokophobie eine vulnerable Gruppe sind, wird Wissen benötigt, wie ihre sozialen Interaktionen für schwangere Frauen mit gAvG bedeutungsvoll sind im Hinblick auf ihre Angst. OPEN ACCESS

Article

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Mar 2020

Hintergrund: Da Schwangere mit großer Angst vor der Geburt (gAvG)/Tokophobie eine vulnerable Gruppe sind, wird Wissen benötigt, wie ihre gesundheitliche Versorgung ein positives Schwangerschafts- und Geburtserlebnis ermöglichen kann. Diese Studie exploriert, wie sich Angst vor der Geburt entwickelt und welche Erlebnisse und Erfahrungen in sozialen Interaktionen für schwangere Frauen mit gAvG bedeutungsvollsind im Hinblick auf ihre Angst Methodik: Zwölf Schwangere mit gAvG nahmen an problem-zentrierten Interviews teil. Die rekonstruktive Analyse erfolgte mit der Dokumentarischen Methode nach Bohnsack mit dem Ziel, kollektive Orientierungs-muster (sinngenetische Typenbildung des Habitus) herauszuarbeiten. Ergebnisse: Schwangere mit gAvG sehen weder im privaten noch im professionellen Umfeld ausreichend Gelegenheit für bestärkende Gespräche über die Geburt. Berichte von Notfällen und Komplikationen empfinden sie als sehr belastend. Sie wünschen sich eine Hebamme mit der Kompetenz, mit ihrer Angst umzugehen, Informationen über die Geburt konstruktiv zu vermitteln und die Geburtsvorbereitung und -betreuung unterstützend und bestärkend zu gestalten. Schlussfolgerung: Hebammen benötigen spezielle Kenntnisse, um die Betreuung von Schwangeren mit gAvG didaktisch zielführend zu gestalten. Um gAvG frühzeitig zu erkennen, wird ein deutschsprachiges validiertes Assessmentinstrument benötigt. In zukünftiger Forschung könnte der Kenntnisstand durch eine soziogenetische Typenbildung von Schwangeren mit gAvG erweitert werden. Schlüsselwörter: Angst vor der Geburt, Hebamme, Versorgungswünsche, Schwangerschaft, klinische Geburtshilfe

Self-efficacy, psychological well-being and perceived social support levels in pregnant women

Article

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Sep 2019

S 4674 SELF-EFFICACY, MENTAL WELL BEING AND SOCIAL SUPPORT PERCEPTION LEVELS OF PREGNANCIES

Article

Nov 2018

Maternal Anxiety and Its Associated Factors During the First and Second Wave of COVID-19 Pandemic in Serbia: A Cross-Sectional Study

Article

Full-text available

Dec 2022

Aim: The COVID 19-pandemic affects people differently, while pregnant women are among the most sensitive populations. The data about maternal mental health during the COVID-19 outbreak are in some ways consistent but also country-specific. Purpose: The study aims to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify its associated factors. Patients and methods: This cross-sectional study included a sample of 358 pregnant women during the first and second waves of the pandemic in Serbia. An anonymous survey included basic demographic questions, pregnancy-related background questions, the question of self-reported COVID-19-related fear, State-Trait Anxiety Inventory (STAI), and Multidimensional Scale of Perceived Social Support (MSPSS). Results: The study revealed no pregnant women with low anxiety levels measured by STAI-T and STAI-S, while the STAI-S and STAI-T scores indicated high anxiety in 32.4% and 42.7% of pregnant women, respectively. The obtained results pointed out the nonlinear dependence of state anxiety on observed associated factors and their complex interactions, including the data collecting period. Conclusion: Our findings reveal that COVID-19 affects pregnant women's mental health and makes it necessary for psychological monitoring and support for pregnant women, which may be reflected in their mental health but also the development of their offspring.

The effect of expressive writing on fear of childbirth among nulliparous pregnant women: A randomized controlled trial

Article

Jan 2022

Background: Fear of childbirth (FOC) is a common and complicated problem among nulliparous pregnant women. Objectives: The aim of this study was to compare the effects of expressive writing and neutral writing on FOC in nulliparous pregnant women. Methods: A randomized controlled trial was conducted on 90 nulliparous pregnant women referred to selected comprehensive health centers in Isfahan for prenatal care from May 1 to September 30, 2021. The participants were recruited consecutively and randomly allocated to two groups to perform either expressive writing or neutral writing at home for 20 min daily for 7 days. Before and after the intervention, FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire. Paired t-test, independent t-test, and Chi-square were used for statistical analysis. Results: The mean age of pregnant women was 29.93 ± 5.20 and 29.18 ± 5.65 years in the usual and expressive writing groups, respectively. The mean FOC scores of the women in the neutral writing and expressive writing groups were 36.31 ± 7.35 and 35.96 ± 6.80, respectively, at baseline (P = 0.81) and changed to 34.98 ± 8.18 and 31.58 ± 7.99, respectively, at the end of the study (P < 0.04). The paired t-test showed that the mean FOC score of the expressive writing group decreased significantly at the end of the study (P < 0.001), whereas it did not change significantly in the neutral writing group (P = 0.11). Conclusion: Expressive writing can reduce FOC in nulliparous pregnant women and can be used as an effective, low-cost, simple, and accessible method.

The effect of the training program provided to primiparous pregnant women through the motivational interview method on their fear of childbirth, childbirth self-efficacy, and delivery mode: a randomized controlled trial

Article

Full-text available

Jun 2022
CURR PSYCHOL

Fear of childbirth negatively affects women during pregnancy and after birth. The research was conducted to evaluate the effect of the training program provided to primiparous pregnant women through motivational interview method on fear of childbirth, childbirth self-efficacy, and delivery mode. This is a parallel-randomized controlled experimental study. "Training Program through Motivational Interview Method for Fear of Childbirth" was applied individually to 37 pregnant women in the intervention group, once a week, for four sessions in total while 36 in the control group did not receive any intervention other than routine hospital practices. In the collection of the research data, Introductory Information Form, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) Versions A and B, the Childbirth Self-Efficacy Inventory-Short Form (CBSEI-SF), and the Delivery Evaluation Form were used. It was determined that the mean W-DEQ scores of those in the intervention group obtained during the 37th to 40th weeks of gestation and postpartum were lower than those in the control group. It was found that, during the 37th to 40th weeks of gestation, the intervention group’s median scores for the CBSEI-SF total score, Sub-dimension of Expectation of Outcome, and Sub-dimension of Expectation of Self-Efficacy were higher than those of in the control group. There was no significant difference between the groups regarding their delivery mode. While the training program given to primiparous pregnant women through the motivational interview method was found to have reduced the fear of childbirth and increased their childbirth self-efficacy, it had no effect on the delivery mode.

Predictors of severe labor pain: prospective observational study.

Preprint

Full-text available

Mar 2022

Introduction: Pain during childbirth is a complex and subjective experience that every mother experiences differently [1]. The degree of a woman's suffering in childbirth depends on the intensity of labor pain and many indirect factors [2]. Complex interrelated effects on labor pain are limited by the little number of studies available. That is why it is necessary to determine the probable factors that may affect the intensity of pain. In accordance with this, determining predictors of the intensity of pain during vaginal delivery remains an important issue for the maternity health policy. Aim: Investigate predictors of severe labor pain. Method: A prospective observational study was conducted in the period from December 2020 to May 2021 at the Kyiv City Maternity Hospital №5 (Kyiv, Ukraine). Logistic regression was used to measure the influence of risk factors on the probability of severe labor pain. Results: The examined predictors were derived from mothers` self-report of overall childbirth. 366 women took part in research, 282 of them rated their pain by ≤ 60 mm visual analog scale (VAS), while 84 patients reported their pain by ≥70 mm VAS. The study identified predictors that reduce the risk of severe labor pain, such as a woman's prenatal health (namely, a healthy prenatal woman) (OR 0.0967 [95% CI 0,0344 - 0,2719], p=0,0001), attendance of maternal school (OR 0.0978 [95% CI 0.0541 - 0.1767], p<0,0001), doula`s help (OR 0,1266 [95% CІ 0,0711 - 0,2255], p<0,0001) and feeling of control over pain in labor (OR 0,0176 [95% CІ 0,0086 - 0,0359], p<0,0001). In addition, predictors such as first delivery (OR 1.67 [95% CI 1.0240 - 2.7387], p=0,04) and prenatal anxiety (OR 9.1277 [95% CI 5.2973 - 15.7276], p<0,0001) in contrast to the factors listed above, increase the risk of severe labor pain. Conclusion: Significant predictors of severe labor pain were identified through this study. The findings are useful in the maternal care system by focusing on early prevention of treatment labor pain. ClinicalTrials.gov: Retrospectively registered on February 23, 2022, NCT05226208

Evaluation of Primigravida Women's Childbirth Self-efficacy at Al-Elwea Maternity Hospital in Baghdad City.

Article

Full-text available

Oct 2021

Pregnant women who believe themselves have capabilities to cope with childbirth, they feel able to control labor stress. On the other hand, if they believe themselves uncappable to cope with labor, they cannot control labor stress and may choose cesarean delivery. Objectives: To evaluate women's self-efficacy of childbirth and find out the association between women's self-efficacy and study variables. Methods: Descriptive study of non-probability (purposive sample) was used to collect the data from (100) women. A pilot-test was conducted to determine the reliability of the questionnaire. Data were analyzed through the use of SPSS. Results: The higher percentage of women's age was (20-29) years graduated from secondary school. About one-third of them in gestational age 32 weeks. More than two-thirds of them are preferred cesarean birth. They have a low childbirth self-efficacy. There are significant differences between women's age, education, occupation, delivery preference, and childbirth self-efficacy. Conclusion: This study finds that primigravida women have low childbirth self-efficacy, and there are significant differences between women's self-efficacy with the demographic and reproductive variables.

The factor structure of the childbirth self-efficacy inventory in a sample of Turkish pregnant women

Article

Full-text available

Nov 2021

Self-efficacy in Relation to Adherence to Healthy Behaviors among Pregnant Women: A concept Analysis

Article

Full-text available

Jun 2022

Aim: This study aims to provide an understanding of the concept of self-efficacy in its implications in promoting adherence to healthy behaviours among pregnant women. Design: Concept analysis guided by Wilson 1963 framework. Methods: An electronic search of the literature published from 2009-2019 was conducted using the following databases: CINAHL, PubMed, ERIC, PsycINFO, and Google Scholar. After an in-depth review of the literature, the data were analysed, and the findings were synthesized. Results: It was found that self-efficacy is a multidimensional, dynamic, and contextual concept that is shaped according to a pregnant woman's previous experiences, the gained knowledge, presence of family empowerment, professional support, and the woman's emotional status. Self-efficacy influences a pregnant woman's cognitive process by taking quality decision-making, setting practical goals, and having a plan to overcome barriers and challenges. Conclusion: Self-efficacy is an essential predictor of adherence to the recommended healthy behaviours; hence, it should be part of any prenatal health promotion interventions.

Comparison of fear, anxiety and self-efficacy of childbirth among primiparous and multiparous women

Article

Full-text available

Sep 2021

Background The aim of this study was to compare fear of childbirth, state and trait anxiety, and childbirth self-efficacy among primiparous and multiparous women in Ahvaz, southwest of Iran. Methods This cross-sectional study was conducted with 200 pregnant women (100 primiparous and 100 multiparous women) who had been admitted to the maternity ward of hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The instruments used for data collection in this study included a demographic questionnaire, Delivery Fear Scale (DFS), Spielberger's State-Trait Anxiety Inventory (STAI), and Childbirth Self-Efficacy Inventory (CBSEI). The data were analyzed by chi-square test and independent t-test. Also, the univariate general linear model was used by adjusting for the socio-demographic and obstetric characteristics that were considered as possible confounding variables. Results The mean score of DFS in primiparous women was significantly higher than that of multiparous women. The mean of the overall score of childbirth self-efficacy of primiparous women was significantly lower than that of multiparous women. The mean score of the outcome expectancies and self-efficacy expectancies was significantly lower in primiparous women compared with multiparous women. There was no statistically significant difference between the two groups in terms of the mean score of STAI. After adjusting for possible confounding variables, the differences between the two groups in terms of fear of childbirth scores, overall childbirth self-efficacy score and self-efficacy expectancies remained significant. Conclusion Given the high fear of childbirth and low childbirth self-efficacy in primiparous women compared to the multiparous women, appropriate interventions should be adopted by health care providers in order to reduce fear and improve childbirth self-efficacy in primiparous women.

Effectiveness of Educational program on Primigravida Women’s Childbirth Self-Efficacy at Al-Elwea Maternity Hospital in Baghdad City

Article

Full-text available

Apr 2021

Women’s perception of labor pain severity varies depending on several factors such as self-efficacy, her expectations, readiness for childbirth, anxiety, and support. Objectives: To determine the effectiveness of the educational program on primigravida women’s childbirth self-efficacy (CBSE) and to find out the relationship between CBSE and demographical, reproductive variables. Methods: Quasi-experimental study design pre-test and post-test for both the study and the control group. The educational program provided for the study group and post-test conducted in the first stage of labor for both groups. Data were analyzed through the use of SPSS. Results: The highest percentage of primigravida women have a low CBSE among both groups. There are no significant differences between the study and control group in the pre-test period however, there are highly significant differences between study and control group in the post-test period. There are significant differences between women’s CBSE and some study variables during the pre-test, which include women’s age, delivery preference, educational level, and childbirth. Conclusion: Childbirth self-efficacy among primigravida women was low before receiving the educational program however, it was enhanced in the post-test period. The educational program is effective in enhancing CBSE. Recommendations: Further studies are required to evaluate CBSE among a large number of nulliparous and multiparous at various hospitals to identify factors determinant for and CBSE.

Well-being, self-esteem and body satisfaction in new mothers

Article

Full-text available

Apr 2021

Background: How mother’s recall their experience of childbirth, their concerns about body image, their sense of competence in parenting, and their combined sense of self-esteem are all factors with the potential to impact on mental well-being. Method: A total of 234 women, who had given birth within the past 3 years, completed a survey comprised of the Birth Memories and Recall Questionnaire, the Parenting Sense of Competence Scale, the Warwick–Edinburgh Mental Well-being Scale, the Rosenberg Self-Esteem Questionnaire and the Body Shape Questionnaire. Results: Mothers who have higher body dissatisfaction show significantly lower well-being, self-esteem and perceived parenting competence. Mothers who experienced higher levels of mental well-being were found to have higher levels of perceived parenting competence and self-esteem, and those who experienced higher levels of self-esteem were also found to have higher levels of perceived parenting competence. Conclusion: Memories of the birth experience, perceived postpartum body image, parenting sense of competence and self-esteem have a combined and complex relationship with mental well-being. Health care professionals should inform mothers about the body changes which may occur throughout the postpartum period, to encourage mothers not to be deceived by media images and to stress the importance of realistic expectations following giving birth.

Women's Expectations and Experiences Regarding Nursing Support during Childbirth

Article

Full-text available

Oct 2019

Context: Women giving birth always need to be provided by support and care during childbirth, trustful relationships with the health professionals, mainly childbirth nurses. The midwife can promote women feeling of being empowered and subsequently having positive experience and satisfaction during childbirth. Aim: The study aimed to assess the women's expectations and experiences regarding nursing support during childbirth. Methods: A descriptive design utilized in carrying out this study. A purposive sample of 400 women recruited in this study that conducted at the antenatal clinic and postnatal room, Ain Shams University Maternity Hospital. The study utilizes three tools: A structured interview questionnaire to assess socio-demographic characteristics of the study sample, the expectations of nursing support during labor and birth, and the childbirth experience questionnaire. Results:58.3% of the studied sample had negative expectations toward nursing support.62.6% of the studied sample had negative experiences toward childbirth. Conclusions: The study concluded that more than half of the studied sample had negative expectations toward nursing support. Besides, slightly less than two-thirds of the studied sample had negative experiences toward childbirth. Also, there was a highly significant correlation between the total expectations of the nursing support score of the studied sample and their total childbirth experiences. The study recommended conducting an educational program to childbirth nurses regarding expectant mothers' expectations, wishes, and needs during labor.

COVID-19 and Mental Health During Pregnancy: The Importance of Cognitive Appraisal and Social Support

Article

Jan 2021
J AFFECT DISORDERS

Background : Pregnancy is a period of elevated risk for mental health difficulties, which are likely exacerbated by the COVID-19 pandemic. This study aims to understand the impact of COVID-19 on mental health and identify risk and protective factors during pregnancy. Methods : Participants were 303 pregnant individuals from Ontario, Canada. Depression, anxiety and insomnia were measured using validated questionnaires. COVID-related experiences (i.e., financial difficulties, relationship conflict, social isolation) were assessed in relation to mental health. Social support and cognitive appraisal of the pandemic were examined as protective factors. Results : 57% of the sample reported clinically elevated depression, >30% reported elevated worries, and 19% reported elevated insomnia. Depression (t = 25.14, p < .0001) and anxiety (t = 17.21, p < .0001) levels were higher than non-COVID pregnant samples. Social isolation, financial trouble, relationship difficulties and threat of COVID-19 were associated with mental health. Social support (rrange -.24 to -.38, p <.01) was associated with lower mental health problems and negative cognitive appraisal (rrange .20 to .33, p <.01) was linked to more mental health problems. Furthermore, social support and cognitive appraisal interacted (β = -.92, SE = .41, p < .05), such that higher social support acted as a protective factor, particularly for those who appraise the impact of COVID-19 to be more negative. Conclusions :. Findings underscore the need to address the high rates of mental health during pregnancy and outline potential targets (cognitive appraisal and social support) to protect pregnant people from experiencing mental health problems during the COVID-19 pandemic.

Fear of childbirth and sense of coherence with their determinants in endangered and healthy pregnancies

Article

Full-text available

Sep 2020

Paula Emilia Złakowska

Introduction The growing number of Cesarean sections and the percentage of women dissatisfied with perinatal care are the one of the main problems of modern gynaecology in Poland. It seems that if women with a high fear of delivery and a low sense of coherence are scanned early enough, it can contribute to better psychological care and greater satisfaction while giving birth. Objective The aim of the study is to compare the level of fear of childbirth and sense of coherence between endangered and healthy pregnancies. Material and methods The study was conducted in one centre in Lublin, Poland, which involved 29 women in endangered pregnancies. The comparative group consists of 30 women in healthy pregnancy, tested online. Antonovsky’s Sense of Coherence Scale (SOC) and Fear of Childbirth Questionnaire were used for the study. Results The results showed that women in endangered pregnancy significantly differ in terms of the level of fear of delivery, comprehensibility, manageability and general sense of coherence from women who are not in endangered pregnancy. The Cohen’s d size indicates that women who are in high-risk pregnancy have a significantly higher level of fear of childbirth than women in healthy pregnancy. Cohen›s d index also indicates that women in endangered pregnancy have a significantly lower level of comprehensibility, manageability and general sense of coherence compared to the control group. Conclusions Screening pregnant women with ready-made questionnaires and providing professional psychological care can possibly prevent excessive escalation of childbirth anxiety and decrease the number of Cesarean sections. By increasing the sense of coherence, we can help in better management of pregnancy and improve the overall experience.

Supporting perinatal anxiety in the digital age; a qualitative exploration of stressors and support strategies

Article

Full-text available

Jun 2020

Background: The period surrounding childbirth is one of profound change, which can often be experienced as stressful and overwhelming. Indeed, around 20% of women may experience significant levels of anxiety in the perinatal period. However, most women experiencing perinatal anxiety (PNA) go unrecognised and untreated. The Internet offers a potentially scalable solution to improve access to support, however a dearth of research in this area means that work is needed to better understand women's experience of PNA, so that potential targets for intervention can be identified and possible barriers to support overcome. This study aimed to qualitatively explore women's experience of anxiety triggers and support in the perinatal period; and gain insight into what online support is acceptable for women with PNA. Methods: Women who were either pregnant or within one-year postpartum were invited to participate in focus groups across the UK. Focus groups were used to allow a diversity of perspectives to be heard, while simultaneously promoting the identification and prioritisation of important support needs and solutions. Interviews were transcribed and thematically analysed. Results: Five key themes emerged in relation to women's experience with PNA: holding unrealistic expectations of birth and motherhood; stigma; the importance of peer support; uncertainty and poor maternal confidence; and a lack of mental health support and knowledge. Perinatal women felt under-supported and poorly prepared for motherhood. A mismatch between their expectations and the reality of their experience, alongside a pressure to be the 'perfect mum' was the primary source of their anxiety. Furthermore, stigma associated with PNA may have exacerbated these issues and led to help-seeking avoidance. Overall, women felt these issues could be addressed via online support, through the delivery of more realistic information, providing psychoeducation about PNA symptoms and management, and the inclusion of authentic peer experiences. Thus, delivering evidence-based information and interventions online may provide a solution that is acceptable to this cohort. Conclusions: This work provides unique insight into potential sources of anxiety for women in the perinatal period, while also offering potential internet-based support solutions that are likely to be acceptable and helpful for women with PNA.

Supporting perinatal anxiety in the digital age; A qualitative exploration of stressors and support strategies.

Preprint

Full-text available

Sep 2019

Background: The period surrounding childbirth is one of profound change, which can often be experienced as stressful and overwhelming. Indeed, around 20% of women may experience significant levels of anxiety in the perinatal period. However, most women experiencing perinatal anxiety (PNA) go unrecognised and untreated. The Internet offers a potentially scalable solution to improve access to support, however a dearth of research in this area means that work is needed to better understand women’s experience of PNA, so that potential targets for intervention can be identified and possible barriers to support overcome. This study aimed to qualitatively explore women’s experience of anxiety triggers and support in the perinatal period; and gain insight into what online support is acceptable for women with PNA. Methods: Women who were either pregnant or within one-year post-partum were invited to participate in focus groups across the UK. Focus groups were used to allow a diversity of perspectives to be heard, while simultaneously promoting the identification and prioritisation of important support needs and solutions. Interviews were transcribed and thematically analysed. Results: Five key themes emerged in relation to women’s experience with PNA: holding unrealistic expectations of birth and motherhood; stigma; the importance of peer support; uncertainty and poor maternal confidence; and a lack of mental health support and knowledge. Perinatal women felt under-supported and poorly prepared for motherhood. A mismatch between their expectations and the reality of their experience, alongside a pressure to be the ‘perfect mum’ was the primary source of their anxiety. Furthermore, stigma associated with PNA may have exacerbated these issues and led to help-seeking avoidance. Overall, women felt these issues could be addressed via online support, through the delivery of more realistic information, providing psychoeducation about PNA symptoms and management, and the inclusion of authentic peer experiences. Thus, delivering evidence-based information and interventions online may provide a solution that is acceptable to this cohort. Conclusions: This work provides unique insight into potential sources of anxiety for women in the perinatal period, while also offering potential internet-based support solutions that are likely to be acceptable and helpful for women with PNA.

Supporting perinatal anxiety in the digital age; A qualitative exploration of stressors and support strategies.

Preprint

Full-text available

Feb 2020

Background: The period surrounding childbirth is one of profound change, which can often be experienced as stressful and overwhelming. Indeed, around 20% of women may experience significant levels of anxiety in the perinatal period. However, most women experiencing perinatal anxiety (PNA) go unrecognised and untreated. The Internet offers a potentially scalable solution to improve access to support, however a dearth of research is area means that work is needed to better understand women’s experience of PNA, so that potential targets for intervention can be identified, and possible barriers to support overcome. This study aimed to qualitatively explore women’s experience of anxiety triggers and support in the perinatal period; and gain insight into what online support is acceptable for women with PNA. Methods: Women who were either pregnant or within one year post-partum were invited to participate in focus groups across the UK. Focus groups were used to allow a diversity of perspectives to be heard, while simultaneously promoting the identification and prioritisation of important support needs and solutions. Interviews were transcribed and thematically analysed. Results: Five key themes emerged in relation to women’s experience with PNA: holding unrealistic expectations of birth and motherhood; stigma; the importance of peer support; uncertainty and poor maternal confidence; and a lack of mental health support and knowledge. Perinatal women felt under-supported and poorly prepared for motherhood. A mismatch between their expectations and the reality of their experience, alongside a pressure to be the ‘perfect mum’ was the primary source of their anxiety. Furthermore, stigma associated with PNA may have exacerbated these issues and led to help-seeking avoidance. Overall, women felt these issues could be addressed via online support, through the delivery of more realistic information, providing psychoeducation about PNA symptoms and management, and the inclusion of authentic peer experiences. Thus, delivering evidence-based information and interventions online may provide a solution that is acceptable to this cohort. Conclusions: This work provides unique insight into potential sources of anxiety for women in the PNA, while also offering potential internet-based support solutions that are likely to be acceptable and helpful for women with PNA.

Socioeconomic risk factors for labour induction in the United Kingdom

Article

Full-text available

Mar 2020

Background: Labour induction is a childbirth intervention experienced by a growing number of women globally each year. While the maternal and socioeconomic indicators of labour induction are well documented in countries like the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom. This paper explores the relationship between labour induction and maternal demographic, socioeconomic, and health indicators by parity in the United Kingdom. Method: Logistic regression analyses were conducted using the first sweep of the Millennium Cohort Study, including a wide range of socioeconomic factors such as maternal educational attainment, marital status, and electoral ward deprivation, in addition to maternal and infant health indicators. Results: In fully adjusted models, nulliparous and multiparous women with fewer educational qualifications and those living in disadvantaged places had a greater likelihood of labour induction than women with higher qualifications and women in advantaged electoral wards. Conclusions: This paper highlights which UK women are at higher risk of labour induction and how this risk varies by socioeconomic status, demonstrating that less advantaged women are more likely to experience labour induction. This evidence could help health care professionals identify which patients may be at higher risk of childbirth intervention.

Relación entre el personal de enfermería y las gestantes durante el trabajo de parto

Article

Full-text available

Jan 2020

Objetivo: Describir la relación entre el personal de enfermería y las gestantes durante el trabajo de parto, desde la perspectiva de las pacientes. Métodos: Estudio descriptivo, transversal, correlacional, se realizó un muestreo a conveniencia incluyendo el 95,4 % de la población de estudio. Se aplicó un cuestionario ad hoc, diseñado a la luz de las fases de la comunicación interpersonal descritas por Hildegard Peplau, el cual fue sometido a una prueba piloto y concepto de cinco expertos. Se aplicaron pruebas chi-cuadrado y se construyó un modelo de regresión logística Resultados. Participaron 540 mujeres con edad promedio de 25,6 años (DE 6,0). El 91,9 % valoran como positiva su relación con la enfermera, 8,1 % como negativa. Se encontró que, a mayor edad de la gestante, mejor comunicación con el personal de enfermería (X2 = 15,9 p= 0,003) y que las madres con parto previo tuvieron una mejor experiencia frente al cuidado (X2 = 4,28 p= 0,038). La regresión logística mostró (90% de confianza), que una relación positiva con el personal de enfermería en el parto está relacionada con: la edad (OR=0,9, IC = 0,867 – 0,989), aclarar las dudas frente al parto (OR=18,0, IC = 6,641 – 48,938), evitar el frio (OR=6,1, IC =2,347 – 16,3) y la ayuda para tranquilizarse (OR=4,1, IC = 1,45 – 11,714). Conclusión: Durante el cuidado de la gestante en trabajo de parto, es importante aclarar las dudas, brindar medidas de confort y generar estrategias para tranquilizarse, para establecer una relación interpersonal positiva en la experiencia del trabajo de parto.

The longitudinal course of pregnancy-related anxiety in parous and nulliparous women and its association with symptoms of social and generalized anxiety

Article

Aug 2019
J AFFECT DISORDERS

Background: There is evidence that pregnancy-related anxiety (PrA) has a negative impact on birth outcomes and infant development. However, little is known about worrisome levels and individual trajectories of PrA dimensions across pregnancy and their predictive factors, particularly the association of PrA with symptoms of social phobia (SP) and generalized anxiety disorder (GAD). Methods: A sample of 180 pregnant women was assessed three times during pregnancy with the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2). Linear mixed model analyses were used to investigate the course of different PrA dimensions across pregnancy, and to relate PrA to symptoms of social and generalized anxiety. Additionally, distinct developmental patterns of PrA were explored by latent class growth analyses. Results: While the PrA total score remained stable, the different dimensions of PrA varied significantly over time. After controlling for obstetric and sociodemographic factors as well as depression, perceived social support and self-efficacy, symptoms of SP significantly predicted higher levels of fear of childbirth, child-related worries and concerns about mother´s appearance. Symptoms of GAD predicted higher child-related worries. Moreover, two distinct groups of women with either consistently higher or lower PrA scores were identified. Limitations: Our results are limited due to the use of self-report questionnaires and would benefit from a larger sample size and replication in high-risk samples. Conclusion: Our study suggests that a longitudinal and differentiated investigation of specific forms of prenatal anxiety may improve our understanding of women at high risk for PrA and promote the development of individualized forms of interventions initiated during pregnancy.

Große Angst vor der Geburt bei schwangeren Frauen in Deutschland: Erfahrungen und Orientierungen in Bezug auf die Schwangerenbetreuung und die Geburtsvorbereitung – eine rekonstruktive Studie

Article

Jun 2019

Hintergrund und Ziel: Da Schwangere mit großer Angst vor der Geburt (gAvG)/ Tokophobie eine vulnerable Gruppe sind, wird Wissen benötigt, wie ihre gesundheitliche Versorgung ein positives Schwangerschafts-und Geburtserlebnis ermöglichen kann. Diese Studie exploriert, wie sich Angst vor der Geburt entwickelt und welche Erlebnisse und Erfahrungen in sozialen Interaktionen für schwangere Frauen mit gAvG bedeutungsvoll sind im Hinblick auf ihre Angst. Methodik: Zwölf Schwangere mit gAvG nahmen an problem-zentrierten Interviews teil. Die rekonstruktive Analyse erfolgte mit der Dokumentari-schen Methode nach Bohnsack mit dem Ziel, kollektive Orientierungs-muster (sinngenetische Typenbildung des Habitus) herauszuarbeiten. Ergebnisse: Schwangere mit gAvG sehen weder im privaten noch im professionellen Umfeld ausreichend Gelegenheit für bestärkende Gespräche über die Geburt. Berichte von Notfällen und Komplikationen empfinden sie als sehr belastend. Sie wünschen sich eine Hebamme mit der Kompetenz, mit ihrer Angst umzugehen, Informationen über die Geburt konstruktiv zu vermitteln und die Geburtsvorbereitung und-betreuung unterstützend und bestärkend zu gestalten. Schlussfolgerung: Hebammen benötigen spezielle Kenntnisse, um die Betreuung von Schwangeren mit gAvG didaktisch zielführend zu gestalten. Um sie frühzeitig zu erkennen, wird ein deutschsprachiges validiertes Assessmentinstrument benötigt. In zukünftiger Forschung könnte der Kenntnisstand durch eine soziogenetische Typenbildung von Schwangeren mit gAvG erweitert werden. Schlagwörter: Angst vor der Geburt, Hebamme, Versorgungswünsche, Schwangerschaft, klinische Geburtshilfe Background and study aim: Pregnant women with severe fear of childbirth (FOC)/ tocophobia are a vulnerable group, knowledge is therefore required as to how maternity care can support a positive pregnancy and birth experience. This study explores the development of FOC and which experiences and social interactions are significant in this regard.

Epidural Analgesia During Childbirth and Postpartum Depressive Symptoms: A Population-Based Longitudinal Cohort Study

Article

Jun 2019

Background: Severe pain has been linked to depression, which raises the question of whether epidural analgesia (EDA) during childbirth is associated with a reduced risk of postpartum depression (PPD). This association has been explored previously, but the studies were restricted by small sample sizes and the inability to control for relevant confounders. This study aimed to investigate the association between the administration of EDA and the development of PPD after adjusting for sociodemographic, psychosocial, and obstetric variables. Methods: Data were retrieved from the Biology, Affect, Stress, Imaging and Cognition (BASIC) project (2009-2017), a population-based longitudinal cohort study of pregnant women conducted at Uppsala University Hospital, Sweden. The outcome was PPD at 6 weeks postpartum, defined as a score of ≥12 points on the Edinburgh Postnatal Depression Scale (EPDS). Information was collected through medical records and self-reported web-based questionnaires during pregnancy and 6 weeks after childbirth. Only primiparous women with spontaneous start of childbirth were included (n = 1503). The association between EDA and PPD was examined in multivariable logistic regression models, adjusting for sociodemographic, psychosocial, and obstetric variables. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of the 1503 women included in the analysis, 800 (53%) reported use of EDA during childbirth. PPD at 6 weeks postpartum was present in 193 (13%) women. EDA was not associated with higher odds of PPD at 6 weeks postpartum after adjusting for suspected confounders (age, fear of childbirth, antenatal depressive symptoms; adjusted OR [aOR] = 1.22; 95% CI, 0.87-1.72). Conclusions: EDA was not associated with the risk of PPD at 6 weeks postpartum after adjusting for sociodemographic, psychosocial, and obstetric variables. However, these findings do not preclude a potential association between PPD and childbirth pain or other aspects of EDA that were not assessed in this study.

Childbirth Self-Efficacy and Childbirth Expectation of Adolescent Mothers in Indonesia

Article

Mar 2019

To identify a correlation between childbirth self efficacy and childbirth expectation of adolescent mothers in Indonesia, this cross-sectional study applied consecutive sampling. The sample was 135 adolescent mothers. Instruments utilized were structured questionnaire, including a demographic questionnaire, Child Birth Self-Efficacy Inventory (CBSEI), Childbirth Expectation Questionnaire (CEQ), Marital Adjustment Test (MAT), and London Measure of Unplanned Pregnancy (LMUP). All questionnaires were in Indonesian versions. The correlation of childbirth self-efficacy and childbirth expectation was analyzed using chi-square. Most adolescent mothers had low childbirth self-effication (63.7%). The results showed a significant correlation between childbirth self-efficacy and childbirth expectation of adolescent mothers (p = 0.003, OR 2.8, 95% CI 1.126 to 8.544). These results show that special assistance for adolescent mothers in facing childbirth is necessary to improve self-efficacy.

A systematic mixed-studies review on mindfulness-based childbirth education programs and maternal outcomes

Article

May 2019
NURS OUTLOOK

Background: Mindfulness-based childbirth education programs are gaining popularity among expectant parents. Purpose: To synthesize knowledge on current available evidence of mindfulness-based childbirth education programs on maternal outcomes and to provide recommendations to improve future mindfulness-based childbirth education programs. Method: A mixed-studies systematic review using a narrative synthesis was conducted. Four electronic databases were searched from each database's inception, through November 26, 2018. Findings: Three themes emerged from the synthesis: (a) the duration and receptivity of the programs, (b) improved maternal psychosocial outcomes, and (c) the practice of mindfulness during the postpartum period. A conceptual map was produced. Discussion: The programs resulted in improved maternal psychosocial outcomes. A greater focus on the practice of informal mindfulness should be taught in future mindfulness-based childbirth education programs. Nurses can consider teaching mindfulness techniques in current antenatal classes. The cost effectiveness and receptivity of the programs should be examined. Future mixed-methods longitudinal studies with ideal sample sizes and the exclusion of participants with prior yoga or medication experiences should be conducted.

Fear of birth: Prevalence, counselling and method of birth at five obstetrical units in Norway

Article

Dec 2018

Background: There is increasing evidence that fear of birth can have long-term effects on the childbearing woman and the method of birth. Aim: To examine differences between five hospitals in Norway in the occurrence of fear of birth, counselling received and method of birth. Method: Source data was from the Norwegian cohort of the Bidens study and retrieved through a questionnaire and electronic patient records from five different hospitals in Oslo, Drammen, Tromsø, Ålesund and Trondheim, which included 2145 women. The Wijma Delivery Expectancy Questionnaire measured fear of birth, and a cut-off of ≥85 was used to define fear of birth. Results: In total, 12% of the women reported fear of birth, with no significant differences between the different units. A total of 8.7% received counselling according to hospital obstetrical records, varying significantly from 5.7% in Drammen to 12.7% in Oslo. Only 24.9% of the women with fear of birth had counselling at their hospital. All the units provided counselling for women with fear, but the content varied. Overarching aims included helping women develop coping strategies like writing a birth plan and clearing up issues regarding prior births. A secondary objective was to prevent unnecessary caesarean section. Both primi- and multiparous women who reported fear of birth had a twofold increased risk of a planned caesarean section. Conclusion: There were no differences between five Norwegian hospitals regarding the occurrence of fear of birth. Counselling methods, resources, level of commitment and the number of women who received counselling varied; thus, hospital practices differed.

Measuring women's empowerment during the perinatal period in high income countries: A scoping review of instruments used

Article

Mar 2023

Expectations of the upcoming birth - A survey of women's self-efficacy and birth positions

Article

Oct 2022
Sex Reprod Healthc

Background Adopting an upright sacrum flexible position may facilitate physiological childbirth, which many pregnant women wish for. A positive association between women’s choice on birthing position and birthing experience has been found. Objective The aim of this study was to examine women’s preferred birth position, self-efficacy at term and their actual birth position at time of birth. Methods A survey of 554 pregnant Danish women at gestational week 38. Data was collected using an online survey and information was retracted from the woman’s medical record. Descriptive statistics and non-parametric tests were used and univariate and multivariate logistic regression models were used to analyse the association between self-efficacy and fulfilled wish of birth position. Findings The majority of women (>70%) wished to give birth in a sacrum flexible position but more than 80% gave birth in a non-flexible position. Less than 50% had their wish of birth position fulfilled. All women reported overall high self-efficacy. No difference in having wish for birth position fulfilled was found comparing women with high and low self-efficacy. Conclusions Most women wished for a sacrum flexible position but more than 80% gave birth in a sacrum non-flexible position and less than 50% had their wish for birth position fulfilled. Level of self-efficacy did not affect the likelihood of having wish of birth position fulfilled indicating that the culture at the birth setting and skills and attitudes among birth providers may have a considerable impact on women’s choice of birth position.

Article

Aug 2022

Muafiqoh Dwiarini

p> Background : Childbirth self-efficacy refers to a woman's self-confidence in her ability to cope with labor and contributes significantly to her perception of pain during labor. Mothers with low self-efficacy felt nervous, felt they lacked strength, and expressed more fear, so that the labor process did not go smoothly and lasted longer, causing greater pain for both the mother and baby. Pregnant women with high childbirth self-efficacy had higher intention to attempt vaginal birth, while those choosing caesarean had lower self-efficacy beliefs. Objectives : This study was to determine factors related childbirth self-efficacy among primigravida. Methods : This study used analytic observational method with cross sectional design. This research was conducted at Community Health Centers and two maternity clinics in Yogyakarta with 112 sample pregnant woman. They were recruited using a purposive sampling technique based on the criteria. The study used Childbirth Self-Efficacy (CBSEI) scale, the Fear of Childbirth (FOC) scale, and demographic data questionnaires. The independent sample t-test, ANOVA, pearson’s correlation coefficient, to determine the factors related childbirth self-efficacy. Results : The results of this study indicate that the factors associated with childbirth self-efficacy were antenatal class and prenatal yoga with a p value of 0.000 (p <0.05). In addition, there is a significant negative correlation between childbirth self-efficacy and fear of childbirth (r = -.34, p < .01). In other words, pregnant women with higher childbirth self-efficacy meant less fear of childbirth. Conclusions: Factors related childbirth self-efficacy were antenatal class, prenatal yoga, and fear of childbirth. The results of this study provided a better understanding of factors related childbirth self-efficacy. Based on the results, strategies to increase childbirth self-efficacy should focus on decreasing the level of fear of childbirth, which can be done by attending prenatal education and doing prenatal yoga. </em

Factors relating to childbirth self efficacy among pregnant women: a CHAID analysis

Article

Aug 2022

Childbirth self-efficacy is a useful measure for determining a woman's confidence in managing childbirth and for determining any preconceptions that require reinforcement. Childbirth self-efficacy is also particularly helpful in advising not only how to cope with birth, but also maternal well-being and fostering the improvement of a wide variety of perinatal outcomes. The present study aims to determine the factors affecting childbirth self-efficacy in pregnant women. The sample size consisted of 380 pregnant women between the ages of 18 and 45. Data were collected via face to face interviews using the Childbirth Self Efficacy Scale Short Form (CBSEI-32) in the Akdeniz University Hospital between November 2019 and February 2020 and used Chi-squared Automatic Interaction Detector analyses, resulting in a mean CBSEI-32 score of 244.279 ± 45.121. As a result of the analysis, it was seen that income status affects self-efficacy, and personal experiences such as foetal loss affect a woman’s childbirth self-efficacy. In addition, it was also found that the level of prenatal education affected childbirth self-efficacy. Health professionals should assess pregnant women during the antenatal period in terms of their childbirth self efficacy and prepare personalised training programs and plan initiatives to increase perceptions of self-efficacy. • IMPACT STATEMENT • What is already known on this subject? Childbirth self-efficacy is one of the important psychological parameters to determine a woman's belief in her confidence in managing childbirth and to measure women's perceptions of her need for reinforcement. • What do the results of this study add? Sociodemographic and obstetric characteristics of women affect their childbirth self-efficacy perception positively and negatively. Women's birth self-efficacy can be improved positively with prenatal education. In addition, it is one of the interesting findings of the study that the self-efficacy level of women who had a previous low experience was high. • What are the implications of these findings for clinical practice and/or further research? Women's childbirth self efficacy can be improved with trainings and appropriate nursing interventions. For this reason, it is important to determine the factors affecting the self-efficacy perception of women. In future studies, the childbirth self-efficacy perceptions of women in different samples (risky pregnancy, disabled pregnant, etc.) should be measured.

The effect of Progressive Muscle Relaxation Technique on sleep quality in total hip arthroplasty patients

Article

Full-text available

Jun 2022

Aim: The aim of this study was to investigate the effect of Progressive Muscle Relaxation Technique on sleep quality in patients with total hip arthroplasty. Design: A non-randomized quasi-experimental model was used in this study. Methods: Data were collected using a Personal Information Form and the Turkish translation of the Visual Analog Sleep Scale (VAS Scale). The data was analyzed using percentages and t-test. Results: In comparison with the mean VAS Scale scores between the experimental and the control groups, no significant difference was found between the mean VAS Scale scores of the patients before the surgery and on the night of surgery (p > 0.05). However, a statistically significant difference was found between the mean VAS Scale scores in the first and second postoperative days between groups (p < 0.05). Conclusion: The study found that progressive relaxation exercises improve the quality of sleep. The routine use of progressive relaxation exercises is recommended for patient care plans.

Personality traits, childbirth expectations, and childbirth experiences: a prospective study

Article

Dec 2021

Objectives The current study investigated the role of multiple psychological factors in predicting women’s subjective birthing experiences. Methods An online prospective survey methodology was conducted with women in the US who had never before given birth. Participants (N = 101) completed surveys regarding their personality traits, childbirth fear, and childbirth self-efficacy in their third trimester of pregnancy (range 28–40 weeks gestation). After giving birth (range 5–50 days post birth), participants (N = 58) completed a measure of subjective childbirth experience. Results Significant correlations were found between personality traits, childbirth fear, childbirth self-efficacy, and subjective childbirth experience. Neuroticism, fear, and self-efficacy were all correlated with childbirth experiences. However, regression analysis indicated that only childbirth fear significantly predicted subjective childbirth experiences. Conclusions While previous research has looked at the relationships between personality and expectations or personality and experiences separately, the current findings underscore the importance of including all variables in order to get the most effective picture of the relationships among these variables. The results from the current study can inform methods of identifying women at-risk for negative birth expectations and inform interventions aimed at reducing negative childbirth experiences.

An Exploratory Study of the Role of Birth Stories in Shaping Expectations for Childbirth among Nulliparous Black Women: Everybody is Different (but I'm Scared)

Article

Sep 2021

Introduction Birth stories area source of information and vicarious experience for nulliparous women. Although health disparities research suggests that the childbirth experiences of Black women differ from those of white women, little research has been conducted about the nature of birth stories shared and their subsequent effect on expectations. Methods Pregnant nulliparous Black women were recruited from a women's health practice in the southeastern United States. Participants completed in-depth semistructured interviews about the birth stories they had previously heard and their thoughts about their own upcoming birth experiences. Interviews were audio-recorded and transcribed. Researchers applied the traditions of thematic analysis to identify emergent themes. Results Fourteen women participated in the study (mean age, 28 years). Women reported hearing birth stories from a variety of sources, most commonly mothers and friends. Stories heard generally included details about process, outcome, and social context that often acknowledged past racist hospital policies and experienced discrimination. Women were an active audience to birth stories and sought out stories from some sources, avoided stories from other sources, and used rhetorical strategies to mark stories as either more relatable or less relatable. Women's reported fears, expectations, and choices they planned to make reflected features of the birth stories that they had heard. Discussion Nulliparous women accessed and evaluated birth stories from others and applied knowledge received from those stories to their own experiences. Birth stories played an important role in shaping women's hopes, fears, expectations, and childbirth-related choices. Health care providers should inquire about the birth stores shared with their patients to gain a sense of their childbirth desires and expectations. An appreciation for the importance of knowledge learned from birth stories has the potential to reduce maternal health disparities by improving patient-provider communication through a shared understanding of the patient's goals and fears.

Challenges in using Mental Contrasting with Implementation Intentions (MCII) for preparation for natural birth: A feasibility study

Article

Jun 2021
Sex Reprod Healthc

•Objective •Women who plan a natural birth can benefit from strategies/resources that help them prepare for and cope with labour pain. This study aims to identify the feasibility of using Mental Contrasting with Implementation Intentions (MCII) for preparation of primiparous women for natural childbirth. Secondary aims are to test the acceptability of a health-focused information leaflet, and to describe how participants with high natural birth intentions cognitively prepare for birth. •Methods •In third trimester, ten primiparous women participated in this interventional study with follow-up. A health-focused information leaflet on physiological childbirth, MCII, a mental strategy that helps people achieve a desired goal by envisioning obstacles and how to overcome them, and a researcher-developed questionnaire which contained the CBSEI-C32, was used. Survey data were analysed using a combination of descriptive statistics and deductive theoretical thematic analysis. •Results •The health-focused leaflet was exclusively judged positively. Nine women did not use MCII as instructed, they did not find it helpful for childbirth preparation and wished to have a more positive, health-focused approach towards childbirth. Two themes emerged from the participants’ responses: 'The ability to give birth' which was supported through childbirth preparedness, coping strategies, confidence and external supports and 'the uncertainty of giving birth' which included fears, worries about possible adverse events and the baby’s health. •Conclusion •MCII was not a promising tool for natural childbirth preparation among primiparous women in Germany. Our findings show that women prefer a positive, health-focused approach, rather than thinking about overcoming obstacles, when they prepare for childbirth.

FIRST-TIME DELIVERING WOMEN’S FEAR OF CHILDBIRTH AND IT’S RELATION TO DELIVERY OUTCOMES AT A UNIVERSITY HOSPITAL IN LITHUANIA

Article

May 2021

Introduction. Fear of childbirth (FOC) is a common women’s health problem. It might affect the mother’s and the fetus’ health, complicate and prolong the birth. Women with tokophobia (clinically significant FOC) are more likely to suffer poor birth outcomes. FOC can increase Caesarean section rates with no medical indications. There is no worldwide consensus on the diagnostic protocol and care algorithms for FOC. Material and methods. A prospective study was performed at the tertiary care university hospital (Kaunas, Lithuania). The survey included 110 first-time delivering women at the time of entering the labour ward. A scale and Fear of Delivery Questionnaire (FDQ) questionnaire were used. Medical data were collected from the hospital’s database and analyzed using Microsoft Excel and IBM SPSS software for statistical significance (p < 0.05). Results. According to a subjective scale of FOC (range min 0 – max 10), 37.3% (n = 41) of women stated they experienced FOC. The majority (25.5%; n = 28) rated their fear with 3 points. Absence of fear was indicated by 8.2% (n = 9), and 4.5% (n = 5) felt tokophobia with panic attacks. The majority were worried about newborn health (89.1%; n = 98) and labour pain (79.1%; n = 87). Based on the FDQ questionnaire slightly less than half of the respondents experienced FOC (44.5%; n = 49). No strong associations were found between FOC and neonatal parameters (p > 0.05). Pain relief methods were more frequently chosen by women with FOC (p = 0.032). Patients with FOC gave birth significantly longer than those without FOC (p = 0.047). As FOC increased in score, the time of childbirth also increased (p = 0.02). The method of delivery did not depend on the strength of FOC (p = 0.443). FOC in score was higher for women with a history of abortion (p = 0.036). Conclusions. Nearly half of the interviewed women were experiencing FOC. Newborn health and labour pain were the main reasons for FOC. History of abortion was related to FOC. No strong associations were found between tokophobia and negative newborn outcomes or method of delivery. Significantly longer labour duration was found in women with FOC. Key Message – Fear of childbirth has a great impact on pregnant women’s health and birth itself. Further research is crucial to find effective diagnostic and treatment methods for women with FOC to recognize and help before or even during childbirth. First-time delivering women’s fear of childbirth and it’s relation to delivery outcomes at a university hospital in Lithuania.

The relationship between fear of childbirth and sense of coherence in women expecting their first child

Article

Dec 2020
Sex Reprod Healthc

Objective The aim was to investigate fear of childbirth (FOC) and sense of coherence (SOC), and their components in women expecting their first child. Methods A cross-sectional study where 414 women answered the Wijma Delivery Expectancy Questionnaire Version A and the Sense of Coherence Scale. Statistical analyses were performed. Results The main results show that women with severe FOC reported lower SOC, and all three components of SOC were lower in women with severe FOC. Comprehensibility turned out to have a significant correlation with FOC. Psychological problems before pregnancy were more common in women with severe FOC and low SOC. Conclusions Women with severe FOC reported lower SOC and lower levels of each of the following components: comprehensibility, manageability and meaningfulness.

Original Paper Supporting perinatal anxiety in the digital age; A qualitative exploration of stressors and support strategies.

Preprint

Full-text available

Sep 2019

Background: The period surrounding childbirth is one of profound change, which can often be experienced as stressful and overwhelming. Indeed, around 20% of women may experience significant levels of anxiety in the perinatal period. However, most women experiencing perinatal anxiety (PNA) go unrecognised and untreated. Barriers likely include: poor awareness of PNA, perceived stigma, and the reduced flexibility new mothers face. The Internet offers a potentially scalable solution to overcome these obstacles. Aims and Objectives: This study aimed to qualitatively explore women’s experience of anxiety triggers and support in the perinatal period; and gain insight into what online support is acceptable for women with PNA. Method: Women who were either pregnant or within one year post-partum were invited to participate in focus groups across the UK. Focus groups were used to allow a diversity of perspectives to be heard, while simultaneously promoting the identification and prioritisation of important support needs and solutions. Interviews were transcribed and thematically analysed. Results: Five key themes emerged in relation to women’s experience with PNA: holding unrealistic expectations of birth and motherhood; fear of judgement and pressure to be the ‘perfect mum’; the importance of peer support; poor maternal confidence; and a lack of mental health support and information. Perinatal women felt under-supported and poorly prepared for motherhood. A mismatch between their expectations, and the reality of their experience was the primary source of their anxiety. Furthermore, stigma associated with PNA may have exacerbated these issues and led to help-seeking avoidance. Overall, women felt these issues could be addressed via online support, through the delivery of more realistic information, providing psychoeducation about PNA symptoms and management, and the inclusion of authentic peer experiences. Thus, delivering evidence-based information and interventions online may provide a solution that is acceptable to this cohort. Conclusions: This work provides unique insight into potential sources of anxiety for women in the PNA, while also offering potential internet-based support solutions that are likely to be acceptable and helpful for women with PNA.

Innovations and Evidence Based Practices in Nursing

Article

Apr 2017

Women's labour experiences and quality of care in relation to a prolonged latent phase of labour

Article

Jul 2019
MIDWIFERY

Aim: To describe primiparous and multiparous women's labour experiences and their perception of quality of intrapartum care, in relation to background characteristics and length of latent phase of labour prior to admittance to labour ward. Design: A cross-sectional study. Setting: A middle-sized hospital in a rural county in western part of Sweden. Participants: Primiparous and multiparous women, both low-risk and risk, with a spontaneous onset of labour after gestational week 37+0 were included. In total, n = 1193 women were invited, and n = 757 responded the questionnaire, n = 342 primiparous and n = 415 multiparous women. Methods: The Intrapartal-specific Quality from Patient Perspective (QPP-I), with responses on perceived reality and subjective importance, was used for data collection. QPP-I covers ten factors of quality of care. Background characteristics, length of latent phase of labour, global items about labour experience and items regarding feelings during labour and birth were included. Data were analysed with descriptive and analytic statistics. Findings: All factors in QPP-I were rated higher for subjective importance than perceived reality, except for information about selfcare, for both primi- and multiparous women. Labour experience, perceived reality of quality of care, and feelings were related to length of the latent phase of labour. Primiparous women with a prolonged latent phase (>18 h) had significantly lower scores regarding six out of ten QPP-I factors (PR); Information procedures, Information self-care, Commitment (midwives), Commitment (enrolled nurses), Midwives present, and Partner/ significant others. They scored lower on Experience birth as normal and Safe during labour and birth. The felt less proud and felt more ignored by professionals. Multiparous women with a prolonged latent phase of labour scored significantly lower on one QPP-I factor, Commitment (midwives). They also scored lower on Control over the situation and felt less safe during labour and birth. Key conclusion: Women's perception of quality of intrapartum care, the birth experience and feelings are related to length of the latent phase of labour. Women perceive quality of intrapartum care as being lower than its subjective importance. Implications for practice: A prolonged latent phase of labour can be regarded as a risk factor for a more negative birthing experience.

Skills-based childbirth preparation increases childbirth self-efficacy for first time mothers

Article

Dec 2018
MIDWIFERY

Objective To explore the potential benefits of skills-based childbirth preparation on first time mother's childbirth self-efficacy. Design An RCT of an education programme for skills-based childbirth preparation was conducted. Data were examined for significant differences between groups over time and at outcome. Setting First time New Zealand mothers completed the requirements of the study in the privacy of their own homes. Participants One hundred and eighty-two first time mothers who self-selected met eligibility and were recruited to the study. Of these 137 completed the study (75% retention rate). Intervention An anonymised version of The Pink Kit Method for Birthing Better® (CKT, 2001), a multi-media, skills-based and self-directed childbirth preparation programme. The course includes: breathing exercises, verbal and non-verbal communication exercises, tension reducing exercises, and body exercises as well as advice about stages, delivery methods, and when to use the skills. Measurements the Childbirth Self-Efficacy Inventory (Scale) (CBSEI), New Zealand Adaptation (Lowe, 1993) at 24 weeks and 36 weeks gestation. Findings There were no differences between groups in childbirth self-efficacy at the baseline measurement at 24 weeks gestation. At 36 weeks gestation the Intervention Group showed a significant increase in childbirth self-efficacy. The Intervention Group self-efficacy score was also statistically different from each of the control groups at 36 weeks gestation. Key conclusions A skills-based self-directed childbirth preparation programme was able to increase childbirth self-efficacy in a sample of first time mothers. Implications for practice: Women might be encouraged to participate in these types of skills-based programmes to aid childbirth.

The Effect of Self-Efficacy On Pregnant Women Requesting Cesarean Delivery Instead of Vaginal Delivery in Egypt

Article

Full-text available

Apr 2017

Effect of Educational Intervention on Self-efficacy for Choosing Delivery Method among Pregnant Women in 2013

Article

Full-text available

Oct 2014

Background: Nowadays, there has been a growing trend of caesarean sections in Iran. One reason would be the mother's desire. Increased maternal self-efficacy can be an important step to reduce percentage of cesarean. This study aimed to determine the effectiveness of training-based strategies to increase the self-efficacy for choosing delivery method among pregnant women in Shahrekord city. Methods: This quasi-experimental study was conducted on 130 pregnant women who attended urban health centers in Shahrekord city in 2013. Intervention was applied in the experimental group in three sessions in about 60-90 min while control group did not receive any intervention. Fear of childbirth and self-efficacy questionnaire was completed before and after training. Results: While mean scores of the fear of childbirth, expectations and childbirth self-efficacy before the intervention between the two groups were not significantly different (P > 0.05), mean scores of childbirth in intervention group was reduced and expectation and childbirth self-efficacy had a significant increase after intervention (P < 0.05). In this study, 71.4% of mothers in intervention group and 53.8% of control mothers naturally delivered their children. Most of intervention group mothers desired to deliver through cesarean and had more fear (P < 0.001) but lower childbirth expectation (P > 0.05) and self-efficacy (P < 0.001) than those who chose normal method. Conclusions: Our findings showed that training-based self-efficacy procedure has been effective in encouraging mothers to choose natural childbirth. Therefore, the design and implementation of curriculum-based strategies for increasing self-efficacy is suggested for pregnant women.

Psychometric properties of the Swedish Childbirth Self-Efficacy Inventory (Swe-CBSEI)

Article

Full-text available

Jan 2014

Previous research has reported that women who are admitted to delivery wards in early labour process before an active stage of labour has started run an increased risk of instrumental deliveries. Therefore, it is essential to focus on factors such as self-efficacy that can enhance a woman's own ability to cope with the first stage of labour. However, there was no Swedish instrument measuring childbirth self-efficacy available. Thus, the aim of the study was to translate the Childbirth Self-efficacy Inventory and to psychometrically test the Swedish version on first- time mothers within the Swedish culture. The method included a forward-backward translation with face and content validity. The psychometric properties were evaluated using a Principal Component Analysis and by using Cronbach's alpha coefficient and inter-item correlations. Descriptive statistics and non-parametric tests were used to describe and compare the scales. All data were collected from January 2011 to June 2012, from 406 pregnant women during the gestational week 35-42. The Swedish version of the Childbirth Self-Efficacy Inventory indicated good reliability and the Principal Component Analysis showed a three-component structure. The Wilcoxon Signed-Ranks Test indicated that the women could differentiate between the concepts outcome expectancy and self-efficacy expectatancy and between the two labour stages, active stage and the second stage of labour. The Swedish version of Childbirth Self-efficacy Inventory is a reliable and valid instrument. The inventory can act as a tool to identify those women who need extra support and to evaluate the efforts of improving women's self-efficacy during pregnancy.

Tired, moody and pregnant? Exercise may be the answer

Article

Full-text available

Jul 2013

Negative psychological states such as depression, fatigue and anxiety are experienced by many women during pregnancy. This study examined whether engaging in an exercise programme during pregnancy is associated with improvements in psychological well-being among previously inactive women (n = 56, M age = 30.34, SD = 4.57; M weeks pregnant = 22.58, SD = 5.32). Participants completed the Profile of Mood States-Short Form and State Trait Anxiety Scale-Trait version at baseline and after four weeks of exercise. Exercise was assessed using accelerometers and these data were used to determine bouts of 30-min of moderate-to-vigorous exercise. Factorial repeated measures ANOVAs demonstrated that participants who met Canadian guidelines for exercise during pregnancy at week four (n = 17) experienced significant decreases in depression (p = .004, η (2) = .13), anger (p = .03, η (2) = .08), tension (p = .03, η (2) = .08), fatigue (p = .01, η (2) = .10), trait anxiety (p = .01, η (2) = .12) and increases in vigour (p = .001, η (2) = .19) compared to those who were not meeting guidelines (n = 39). From a psychological health perspective, these findings highlight the importance of continuing to promote exercise during pregnancy.

Participant experiences of mindfulness-based childbirth education: A qualitative study

Article

Full-text available

Nov 2012

Background Childbirth is an important transitional life event, but one in which many women are dissatisfied stemming in part from a sense that labour is something that happens to them rather than with them. Promoting maternal satisfaction with childbirth means equipping women with communication and decision making skills that will enhance their ability to feel involved in their labour. Additionally, traditional antenatal education does not necessarily prepare expectant mothers and their birth support partner adequately for birth. Mindfulness-based interventions appear to hold promise in addressing these issues. Mindfulness-based Child Birth Education (MBCE) was a pilot intervention combining skills-based antenatal education and Mindfulness Based Stress Reduction. Participant experiences of MBCE, both of expectant mothers and their birth support partners are the focus of this article. Methods A generic qualitative approach was utilised for this study. Pregnant women between 18 and 28 weeks gestation, over 18 years of age, nulliparous with singleton pregnancies and not taking medication for a diagnosed mental illness or taking illicit drugs were eligible to undertake the MBCE program which was run in a metropolitan city in Australia. Focus groups with 12 mothers and seven birth support partners were undertaken approximately four months after the completion of MBCE. Audio recordings of the groups were transcribed verbatim and analysed thematically using the method of constant comparison by all four authors independently and consensus on analysis and interpretation arrived at through team meetings. Results A sense of both ‘empowerment’ and ‘community’ were the essences of the experiences of MBCE both for mothers and their birth support partner and permeated the themes of ‘awakening my existing potential’ and ‘being in a community of like-minded parents’. Participants suggested that mindfulness techniques learned during MBCE facilitated their sense of control during birth, and the content and pedagogical approach of MBCE enabled them to be involved in decision making during the birth. The pedagogical approach also fostered a sense of community among participants which extended into the postnatal period. Conclusions MBCE has the potential to empower women to become active participants in the birthing process, thus addressing common concerns regarding lack of control and satisfaction with labour and facilitate peer support into the postnatal period. Further education of health professionals may be needed to ensure that they respond positively to those women and birth support partners who remain active in decision making during birth.

Becoming a mother — an analysis of women's experience of early motherhood

Article

Full-text available

Apr 1997
J ADV NURS

This paper presents the results of a qualitative study conducted by midwife researchers into women's experience of new motherhood. Data were collected using focus groups involving 55 first-time mothers and analysed using grounded theory method. The analysis produced six categories: ‘realizing’, ‘unready’, ‘drained’, ‘aloneness’, ‘loss’ and ‘working it out’. The core category, ‘becoming a mother’, integrates all other categories and encapsulates the process of change experienced by women. Also explained are factors mediating the often distressing experience of becoming a mother. The analysis provides a conceptualization of early motherhood enabling the development of strategies for midwives, nurses and others helping women negotiate this challenge.

Fear of childbirth, mental health, and medication use during pregnancy

Article

Full-text available

Apr 2012
ARCH WOMEN MENT HLTH

The aim of this work was to study the associations between medication use, fear of childbirth, and maternal mental health. Pregnant women (n = 1,984) were recruited through routine antenatal care at a Norwegian hospital from November 2008 through April 2010. Data were collected by three self-completed questionnaires at pregnancy week 17 and 32 and at 8 weeks postpartum. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Checklist (SCL-25) and symptoms of depression by the Edinburgh Postnatal Depression Scale (EPDS). In total, 57.7 % of the women used medications during pregnancy. Analgesics were used by 55.8 % of the women and psychotropic medications by 1.8 %. In all, 7.8 % of the women reported fear of childbirth (W-DEQ >85), the prevalence of anxiety (SCL >18) was 11.8 % and the prevalence of depression (EPDS >13) was 8.1 %. Fear of childbirth was significantly associated with use of psychotropic drugs (OR 3.63; 95 % CI 1.39-9.43) but not with the use of analgesics or medications in general. The presence of symptoms of anxiety or depression increased the magnitude of this association. Fear of childbirth is associated with an increased use of psychotropic medication. This finding could not only be explained by an overlap between fear of childbirth and impaired mental health.

Iranian version of Childbirth Self-Efficacy Inventory

Article

Full-text available

Dec 2008
J CLIN NURS

The primary purpose of this study was to translate the Lowe's Childbirth Self-Efficacy Inventory to Persian and to examine the psychometric properties of its Iranian version. Self-efficacy for childbirth has been found to be a factor in a woman's decision about her choice of delivery and an essential key in coping with labour pain. Creating a valid and reliable questionnaire is necessary to gain a better understanding of the emotional preparation of pregnant women. It is also essential for the development of educational interventions and improving the sense of self-efficacy during pregnancy. Questionnaire translation. The standard 'forward-backward' procedure was applied to translate the questionnaire from English into Persian (Iranian language) and then was reviewed by a panel of experts. We used exploratory factor analysis to examine the construct validity of the instrument. To test the reliability, Cronbach's coefficient alpha was employed. A random sample of 176 pregnant women, attending public prenatal clinics in Tehran, was recruited for participation in the study. The results indicated that each subscales of Childbirth Self-Efficacy Inventory is essentially a unidimensional scale. The results revealed that Iranian pregnant women were able to distinguish between self-efficacy expectancy and outcome expectancy, but they did not differentiate the active phase of labour from second stage. Religious or spiritual beliefs were found to have an important role in the Iranian version of the Childbirth Self-Efficacy Inventory. This preliminary study of the Iranian version of the Childbirth Self-Efficacy Inventory showed that it is an acceptable, reliable and valid measure of women's belief and their confidence in coping with labour pain. A culturally sensitive, reliable and valid instrument is crucial to better understand the self-efficacy of childbirth as a basis for developing effective interventions to increase normal childbirth among Iranian pregnant women.

Giving Birth: Perceptions of Finnish Childbearing Women

Article

Full-text available

Jan 2001
MCN-AM J MATERN-CHIL

To describe the lived experience of childbirth with women giving birth in Finland. Phenomenology. Twenty Finnish women who had recently given birth were interviewed within 2 weeks following childbirth, sharing their perceptions of meaning of their childbirth experiences. Culturally appropriate strategies for qualitative data collection were employed. Trustworthiness of the data was ensured. The richness and diversity of the childbirth experience emerged from the data. One theme identified was a sense of awe at the creation of a new life within the context of birth as a bittersweet paradox. A strong sense of maternal confidence or self-efficacy was identified, which influenced the women's perception of and management of childbirth pain. Feelings of self-actualization were articulated as Finnish women successfully negotiated a challenging life event. Perinatal nurses should increase their sensitivity to the socio-cultural context of giving birth by acknowledging women's experiences as legitimate sources of knowledge.

Implications of Antenatal Depression and Anxiety for Obstetric Outcome

Article

Full-text available

Oct 2004
OBSTET GYNECOL

To investigate the obstetric outcome and health care consumption during pregnancy, delivery, and the early postpartum period in an unselected population-based sample of pregnant women diagnosed with antenatal depressive and/or anxiety disorders, compared with healthy subjects. Participants were 1,495 women attending 2 obstetric clinics in Northern Sweden. The Primary Care Evaluation of Mental Disorders was used to evaluate depressive and anxiety disorders in the second trimester of pregnancy. To assess demographic characteristics, obstetric outcome, and complications, the medical records of the included women were reviewed. Significant associations were found between depression and/or anxiety and increased nausea and vomiting, prolonged sick leave during pregnancy and increased number of visits to the obstetrician, specifically, visits related to fear of childbirth and those related to contractions. Planned cesarean delivery and epidural analgesia during labor were also significantly more common in women with antenatal depression and/or anxiety. There is an association between antenatal depressive and/or anxiety disorders and increased health care use (including cesarean deliveries) during pregnancy and delivery.

Statistical power analysis for the behavioral sciences

Book

Jan 1988

J. Cohen

Self-Efficacy: Toward a Unifying Theory of Behavioral Change

Article

Jan 1977

Albert Bandura

Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)

Self-efficacy: the exercise of control

Book

Jan 1997

A. Bandura

Depression and anxiety in early pregnancy and risk for preeclampsia

Article

Jan 2002

Unraveling The Mystery of Health – How People Manage Stress and Stay Well

Article

Jan 1987

A. Antonovsky

Relation of Self-Efficacy to Reported Pain and Pain Medication Usage During Labor

Article

Sep 2001

We studied the relationship of self-efficacy to reported labor pain and pain medication usage among 43 women. Self-efficacy ratings were judgments of confidence regarding successful completion of tasks involved in labor and delivery (e.g., doing breathing exercises) and in overcoming barriers (e.g., nonsupportive partner). Multiple regression analyses revealed that self-efficacy significantly contributed to predicting labor pain beyond other relevant variables (e.g., age, amount of menstrual pain), with barrier self-efficacy the strongest predictor. Results are discussed in the context of increasing women's confidence in overcoming barriers by incorporating relevant interventions in childbirth education.

Self-efficacy beliefs and fear of childbirth in nulliparous women

Article

Sep 2013
J PSYCHOSOM OBST GYN

Objective: To explore how childbirth self-efficacy, i.e. outcome expectancy and efficacy expectancy, was associated with fear of childbirth (FOC) and how efficacy expectancy and FOC, respectively were related to socio-demographic characteristics, mental problems and preference for a caesarean section. Methods: In this cross-sectional study, a consecutive sample of 1000 pregnant nulliparous women was sent the Wijma Delivery Expectancy Questionnaire and Childbirth Self-Efficacy Inventory. Statistical analyses were performed on data from 423 women. Results: Outcome expectancy and efficacy expectancy correlated significantly and positively, FOC correlated significantly and negatively with both outcome expectancy and efficacy expectancy. Women with severe FOC (20.8%) had a significantly lower level of education (p = 0.001), and had more often sought help because of mental problems (p = 0.004). They were more likely to have low-efficacy expectancy (p < 0.001) and to prefer a caesarean section instead of a vaginal birth (p < 0.001). Conclusions: Lower efficacy expectancy was associated with higher FOC while preference for a caesarean section was not. Improvement of self-efficacy could be a part of care for women with FOC during pregnancy; however, it would not be enough for fearful women who wish to have a caesarean section.

Do self‐efficacy beliefs predict the primiparous labour and birth experience? A longitudinal study

Article

Nov 2009

The objective of this longitudinal study was to determine the predictive role of birth self‐efficacy beliefs in primiparous women's childbirth experiences (n=230). The study had three aims: (1) to determine whether birth self‐efficacy beliefs predict pain tolerance and pain perceptions in labour, (2) whether self‐efficacy beliefs predict obstetric events and birth satisfaction, and (3) whether the relationships between self‐efficacy and pain, and self‐efficacy and obstetric events and self‐efficacy and satisfaction persist when key cognitive, behavioural, social, and demographic covariates are accounted for. A New Zealand‐based longitudinal observational study set was designed. Participants (self‐selected primiparous women) completed the Childbirth Self‐Efficacy Inventory (CBSEI) and cognitive and behavioural constructs at 15 and 35 weeks gestation. Postpartum measures included pain tolerance, labour pain and distress, number and type of obstetric events and birth satisfaction. Hierarchical multiple regressions indicated that stronger birth self‐efficacy beliefs predicted decreased pain and distress in labour, but not pain tolerance. Also, stronger self‐efficacy predicted increased birth satisfaction. The relationships remained significant when covariates were controlled for. The practice implications are that supporting and developing primiparous women's strong birth self‐efficacy beliefs will have an impact on their pain experiences and feelings of satisfaction but is unlikely to influence obstetric events.

Manual for the Profile of Mood States

Article

Jan 1971

Self-Efficacy in Pregnant Women with Severe Fear of Childbirth

Article

Mar 2013
J Obstet Gynecol Neonatal Nurs

Objective: To apply and test the concept of childbirth self-efficacy to expectations of the upcoming birth in the context of severe fear of childbirth (SFOC). Design: Qualitative study using semistructured interviews. Setting: A region in the southeast of Sweden. Participants: Nulliparous pregnant women (N = 17) with SFOC. Method: The interviews were analyzed according to content analysis using deductive and inductive approaches. The seven domains of The Childbirth Self-Efficacy Inventory (CBSEI) made up the matrix for the deductive analysis. Results: Behaviors for coping with labor and childbirth were related to six domains of childbirth self-efficacy: concentration, support, control, motor/relaxation, self-encouragement, and breathing. Most of these behaviors referred to capabilities to carry out (self-efficacy expectancy) rather than to beliefs in effectiveness (outcome expectancy). Five additional subdomains representing defined childbirth self-efficacy were identified: guidance, the body controls, the professionals' control, reliance, and fatalism. Conclusion: The domains of childbirth self-efficacy have been deepened and expanded in relation to SFOC. It is imperative to identify pregnant women with SFOC and their efficacy beliefs to help them find appropriate coping behaviors prior to the onset of labor, and furthermore these behaviors must be supported by health care professionals during labor and childbirth. Support in the form of verbal persuasion emanating from the subdomains of childbirth self-efficacy ought to be added.

Measuring Social Support in Pregnancy: Can It Be Simple and Meaningful?

Article

Dec 2001
BIRTH-ISS PERINAT C

Background:It is important to determine the level of a woman's social support at the booking-in interview for prenatal care, but measurement tends to be ad hoc and nonquantifiable. The purpose of this study was to describe the Maternity Social Support Scale and the relationship between support scale ratings and the Edinburgh Postnatal Depression Scale and other health and service use outcomes.Methods:Women (n= 901) who attended the antenatal clinic at the Royal Women's Hospital in Brisbane, Australia, were asked to complete a support scale as part of their booking-in interview. Participants were contacted at 16 weeks postpartum and invited to complete a follow-up questionnaire. Relationships between the scale and study outcomes were explored using analysis of variance and chi-square tests.Results:Women with low social support in pregnancy were more likely than well-supported women to report poorer health during pregnancy (p= 0.006) and postnatally (p < 0.001), to book later for prenatal care (p= 0.000), to seek medical help more frequently (p= 0.004), and to be more depressed postnatally(p= 0.0001).Conclusion:Social support during pregnancy can be measured in a meaningful and simple way through the use of a short questionnaire administered at the prenatal booking-in visit.

Self-Efficacy: The Exercise of Control

Book

Jan 1997

Albert Bandura

Social Cognitive Theory: An Agentic Perspective

Article

Dec 2002
ASIAN J PSYCHOL

Albert Bandura

This article presents the basic tenets of social cognitive theory. It is founded on a causal model of triadic reciprocal causation in which personal factors in the form of cognitive, affective and biological events, behavioral patterns, and environmental events all operate as interacting determinants that influence one another bidirectionally. Within this theory, human agency is embedded in a self theory encompassing self-organizing, proactive, self-reflective and self-regulative mechanisms. Human agency can be exercised through direct personal agency; through proxy agency relying on the efforts of intermediaries; and by collective agency operating through shared beliefs of efficacy, pooled understandings, group aspirations and incentive systems, and collective action. Personal agency operates within a broad network of sociostructural influences. In these agentic transactions, people are producers as well as products of social systems. Growing transnational imbeddedness and interdependence of societies are creating new social realities in which global forces increasingly interact with national ones to shape the nature of cultural life.

Identification of maternal characteristics associated with the use of epidural analgesia

Article

May 2012
J OBSTET GYNAECOL

The present survey aims to identify predictors associated with the use of epidural analgesia (EA). Therefore, from October 2007 to June 2008, a survey was conducted in 193 pregnant women (mean age 31.7 years (SD 4.9); 64.8% primipara) attending a German general hospital with a specialisation in integrative medicine. Questionnaires, including Antonovsky's sense of coherence (SOC) were delivered antepartum. Delivery data were recorded within the hospital quality management programme. The adjusted odds ratio (OR) for EA use was significantly greater than one for women who had previously used EA (adjusted OR =4.1; CI: 1.03-16.31) and for the desire for a delivery without pain (adjusted OR =3.05; CI: 1.36-6.83). The likelihood of EA use decreased in multipara (adjusted OR =0.05; CI: 0.01-0.22). SOC was not found to be an independent predictor for EA use. However, women with high SOC more often preferred a delivery without EA (p for trend =0.037). In conclusion, first time labour, the desire for a delivery without pain and previous use of EA are independent predictors for the use of EA in labour. Further studies should clarify the predictive role of SOC in pregnancy.

Epidural versus non-epidural or no analgesia in labour (Review)

Article

Dec 2011

Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant. To assess the effects of all modalities of epidural analgesia (including combined-spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011). Randomised controlled trials comparing all modalities of epidural with any form of pain relief not involving regional blockade, or no pain relief in labour. Two of the review authors independently assessed trials for eligibility, methodological quality and extracted all data. We entered data into RevMan and double checked it for accuracy. Primary analysis was by intention to treat; we conducted subgroup and sensitivity analyses where substantial heterogeneity was evident. We included 38 studies involving 9658 women; all but five studies compared epidural analgesia with opiates. Epidural analgesia was found to offer better pain relief (mean difference (MD) -3.36, 95% confidence interval (CI) -5.41 to -1.31, three trials, 1166 women); a reduction in the need for additional pain relief (risk ratio (RR) 0.05, 95% CI 0.02 to 0.17, 15 trials, 6019 women); a reduced risk of acidosis (RR 0.80, 95% CI 0.68 to 0.94, seven trials, 3643 women); and a reduced risk of naloxone administration (RR 0.15, 95% CI 0.10 to 0.23, 10 trials, 2645 women). However, epidural analgesia was associated with an increased risk of assisted vaginal birth (RR 1.42, 95% CI 1.28 to 1.57, 23 trials, 7935 women), maternal hypotension (RR 18.23, 95% CI 5.09 to 65.35, eight trials, 2789 women), motor-blockade (RR 31.67, 95% CI 4.33 to 231.51, three trials, 322 women), maternal fever (RR 3.34, 95% CI 2.63 to 4.23, six trials, 2741 women), urinary retention (RR 17.05, 95% CI 4.82 to 60.39, three trials, 283 women), longer second stage of labour (MD 13.66 minutes, 95% CI 6.67 to 20.66, 13 trials, 4233 women), oxytocin administration (RR 1.19, 95% CI 1.03 to 1.39, 13 trials, 5815 women) and an increased risk of caesarean section for fetal distress (RR 1.43, 95% CI 1.03 to 1.97, 11 trials, 4816 women). There was no evidence of a significant difference in the risk of caesarean section overall (RR 1.10, 95% CI 0.97 to 1.25, 27 trials, 8417 women), long-term backache (RR 0.96, 95% CI 0.86 to 1.07, three trials, 1806 women), Apgar score less than seven at five minutes (RR 0.80, 95% CI 0.54 to 1.20, 18 trials, 6898 women), and maternal satisfaction with pain relief (RR 1.31, 95% CI 0.84 to 2.05, seven trials, 2929 women). We found substantial heterogeneity for the following outcomes: pain relief; maternal satisfaction; need for additional means of pain relief; length of second stage of labour; and oxytocin augmentation. This could not be explained by subgroup or sensitivity analyses, where data allowed analysis. No studies reported on rare but potentially serious adverse effects of epidural analgesia. Epidural analgesia appears to be effective in reducing pain during labour. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labour and long-term neonatal outcomes.

Fear of childbirth; The relation to anxiety and depression

Article

Nov 2011
ACTA OBSTET GYN SCAN

To study the associations of anxiety and depression with fear of childbirth. A cross-sectional questionnaire study. Prenatal public healthcare in Norway. Pregnant women (n=1642) recruited during November 2008 until April 2010. Data were collected by a postal questionnaire at pregnancy week 32. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ) and by a numeric rating scale. Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and symptoms of depression by the Edinburgh Postnatal Depression Scale (EPDS). Fear of childbirth. Eight per cent (137 of 1642) of the women had fear of childbirth (W-DEQ≥85), 8.8% (145 of 1642) had anxiety (SCL-anxiety≥18) and 8.9% (146 of 1642) had depression (EPDS≥12). More than half (56.2%) of the women with fear of childbirth did not have anxiety or depression; however, presence of anxiety or depression increased the prevalence of fear of childbirth (odds ratio 2.4, 95% confidence interval 1.1-5.2 and odds ratio 8.4, 95% confidence interval 4.8-14.7, respectively). Women with both anxiety and depression had the highest prevalence of fear of childbirth (odds ratio 11.0, 95% confidence interval 6.6-18.3). Similar associations of anxiety and depression were estimated by using the numerical rating scale for measuring fear of childbirth. Presence of anxiety and depression increased the prevalence of fear of childbirth; however, the majority of women with fear of childbirth had neither anxiety nor depression.

Swedish midwives' views on severe fear of childbirth

Article

Nov 2011

To describe the views of Swedish midwives on severe fear of childbirth (SFOC). In this cross sectional study, a random sample of 1000 midwives, selected from the database of the Swedish Association of Midwives, received a questionnaire. The response rate was 84% (n=834), with 726 questionnaires included in the final analysis. The views of midwives on SFOC in different contexts of work: antenatal care clinic (ACC), labour ward (LW) either ACC/LW or Neither-Nor ACC/LW. The majority of respondents thought that the frequency of SFOC has increased during the last 10 years (67%), and that pregnant women today are more likely to discuss their fears (70%). Midwives at ACCs thought that special education in SFOC is needed (p<0.001) and that they have more responsibility to identify women with SFOC (p<0.001) than midwives at LWs. The majority of respondents, both at ACCs (60%) and LWs (65%), intuitively sensed when they were meeting a woman with SFOC. Opinions among midwives who alternate between working in ACCs and LWs reflected the views of the midwives working either in an ACC or an LW. The views of midwives on SFOC are partly in concordance and partly contradictory in relation to the different workplaces as well as research data. Knowledge of the views of midwives on SFOC is a necessary pre-requisite to improve care for pregnant women.

Childbirth Self-Efficacy Inventory and Childbirth Attitudes Questionnaire: Psychometric properties of Thai language versions

Article

Jan 2011
J ADV NURS

This paper is a report of the psychometric properties of the Thai language versions of the Childbirth Self-Efficacy Inventory and the Childbirth Attitudes Questionnaire, and the equivalence of the Thai and English versions of these instruments. The Childbirth Self-Efficacy Inventory and the Childbirth Attitudes Questionnaire were developed to measure women's abilities to cope with labour and fear of childbirth. Consistent with Bandura's Self-Efficacy Theory, women who have greater confidence in their ability to cope with labour have reported having less fear in childbirth. However, research is needed to validate the measures and this relationship in countries other than the United States of America, where the tools were developed. Back-translation was used. Content validity was examined by experts. The psychometric properties were estimated with internal consistency reliability, construct validity, contrasted groups and criterion-related validity with 148 pregnant women at a hospital in Thailand in 2008. Both measures were shown to have high internal consistency. Contrasting group and criterion-related validity were consistent with self-efficacy theory and findings in the United States. Differences between the stages of labour across expectancies in the Childbirth Self-Efficacy inventory were found only for second stage. Support for good validity and reliability of the instruments when used with Thai women was demonstrated. It may be appropriate for Thai women to use The Childbirth Self-Efficacy Inventory only in relation to the second stage of labour.

Statistical power ANALYSIS for the Behavioral sciences

Article

Jan 1988
J AM STAT ASSOC

Jacob Cohen

Incluye bibliografía e índice

Journey to Confidence: Women's Experiences of Pain in Labour and Relational Continuity of Care

Article

May 2010
J MIDWIFERY WOM HEAL

An evaluation carried out at King's College Hospital Foundation National Health Service Trust in London identified that women who received continuity of carer from the Albany Midwifery Practice were significantly less likely to use pharmacological pain relief when comparisons were made with eight other midwifery group practices and the local maternity service as a whole. This study was designed to explore women's views of this phenomenon. We conducted a thematic analysis of semistructured, audiotaped, in-depth interviews with 10 women who reflected on their experiences of preparation and support for pain in labour and midwifery continuity of carer with Albany midwives, using a qualitative descriptive methodological approach. Women reflected positively on how, throughout pregnancy and labour, their midwives promoted a sense of their ability to cope with the challenge of labour pain. This building of confidence was enabled through a relationship of trust that developed with their midwives and the value of hearing other women's stories during antenatal groups. These experiences enhanced women's ability to overcome fears and self-doubt about coping with pain and led to feelings of pride, elation, and empowerment after birth. Women valued being encouraged and supported to labour without using pharmacological pain relief by midwives with whom they developed a trusting relationship throughout pregnancy. Features of midwifery approaches to pain in labour and relational continuity of care have important implications for promoting normal birth and a positive experience of pregnancy, labour, and birth for women.

Childbirth Fear, Anxiety, Fatigue, and Sleep Deprivation in Pregnant Women

Article

Sep 2009
J Obstet Gynecol Neonatal Nurs

To explore women's levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the third trimester of pregnancy. A cross-sectional descriptive survey of a community sample. Six hundred and fifty English-speaking nulliparous and multiparous women, 17 to 46 years of age and between 35 and 39 weeks gestation, with uncomplicated pregnancies. Wijma Delivery Expectancy/Experience Questionnaire, Spielberger State Anxiety Inventory, Mindell's Sleep Questionnaire, and the Multidimensional Assessment of Fatigue Questionnaire. Twenty-five percent of women reported high levels of childbirth fear and 20.6% reported sleeping less than 6 hours per night. Childbirth fear, fatigue, sleep deprivation, and anxiety were positively correlated. Fewer women attending midwives reported severe fear of childbirth than those attending obstetricians. Women with high childbirth fear were more likely to have more daily stressors, anxiety, and fatigue, as well as less help. Higher levels of anxiety predicted higher levels of childbirth fear among women. One fourth of women reported high childbirth fear. Women's fear of childbirth was related to fatigue, available help, stressors, and anxiety. Fear of childbirth appears to be part of a complex picture of women's emotional experiences during pregnancy.

Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health System

Article

Oct 2009
HEALTH SERV RES

Objective: To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness. Linked California hospital discharge (2000-2001), birth, fetal death, and county mental health system (CMHS) records. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors. Compared with deliveries in the general non-mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis). Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention.

An intervention to improve women's ability to cope with childbirth

Article

Sep 2009
J CLIN NURS

To test the effectiveness of an efficacy-enhancing educational intervention to promote women's self-efficacy for childbirth and coping ability in reducing anxiety and pain during labour. The evidence of the effective application of the self-efficacy theory in health-promoting interventions has been well established. Little effort has been made by health professionals to integrate self-efficacy theory into childbirth care. Randomised controlled trial. An efficacy-enhancing educational intervention based on Bandura's self-efficacy theory was evaluated. The eligible Chinese first-time pregnant women were randomly assigned to either an experimental group (n = 60) or a control group (n = 73). The experimental group received two 90-minute sessions of the educational programme in between the 33rd-35th weeks of pregnancy. Follow-up assessments on outcome measures were conducted within 48 hours after delivery. The short form of the Chinese Childbirth Self-Efficacy Inventory was used to measure maternal self-efficacy prior to labour. Evaluation of pain and anxiety during the three stages of labour and performance of coping behaviour during labour were measured by the Visual Analogue Scale and Childbirth Coping Behaviour Scale respectively. The experimental group was significantly more likely than the control group to demonstrate higher levels of self-efficacy for childbirth (p < 0.0001), lower perceived anxiety (p < 0.001, early stage and p = 0.02, middle stage) and pain (p < 0.01, early stage and p = 0.01, middle stage) and greater performance of coping behaviour during labour (p < 0.01). The educational intervention based on Bandura's self-efficacy theory is effective in promoting pregnant women's self-efficacy for childbirth and reducing their perceived pain and anxiety in the first two stages of labour. Relief of pain and anxiety is an important issue for both women and childbirth health professionals. The efficacy-enhancing educational intervention should be further developed and integrated into childbirth educational interventions for promoting women's coping ability during childbirth.

Cognitive processes mediating behavioral change

Article

Apr 1977

The present experiment was designed to test the theory that psychological procedures achieve changes in behavior by altering the level and strength of self-efficacy. In this formulation, perceived self-efficacy. In this formulation, perceived self-efficacy influences level of performance by enhancing intensity and persistence of effort. Adult phobics were administered treatments based upon either performance mastery experiences, vicarious experiences., or they received no treatment. Their efficacy expectations and approach behavior toward threats differing on a similarity dimension were measured before and after treatment. In accord with our prediction, the mastery-based treatment produced higher, stronger, and more generalized expectations of personal efficacy than did the treatment relying solely upon vicarious experiences. Results of a microanalysis further confirm the hypothesized relationship between self-efficacy and behavioral change. Self-efficacy was a uniformly accurate predictor of performance on tasks of varying difficulty with different threats regardless of whether the changes in self-efficacy were produced through enactive mastery or by vicarious experience alone.

Self-Efficacy - Toward A Unifying Theory of Behavioral Change

Article

Apr 1977

Albert Bandura

The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.

The relationship between childbirth self-efficacy and aspects of wellbeing, birth interventions and birth outcomes

Abstract

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