The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Effects of childbirth preparation classes program based on national guideline on fear of childbirth in pregnant women: a randomized clinical trial

Document Type : Original Article

Authors
Maryam Mehrabadi 1
Maryam Masoudifar 2
Aghdas Parvizi 3
Mohammad Hasan Rakhshani 4
Forough Mortazavi 5
1 M.Sc. of Midwifery, Deputy of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
2 General Physician, Center for Communicable Disease Control and Prevention, Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran.
3 B.Sc. of Midwifery, Deputy of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
4 Assistant Professor, Department of Biostatistics, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
5 Associate Professor, Department of Midwifery, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
10.22038/ijogi.2020.15737
Abstract
Introduction: Fear of childbirth increases obstetrical interventions, and causes complications for mother and fetus and is one of the important factors affecting the increased rate of cesarean. This study was performed with aim to investigate the effects of childbirth preparation classes program on fear of normal vaginal delivery measured with Wijma Delivery-Expectancy questionnaire.
Methods: This randomized clinical trial study was performed on 132 nulliparous women in Sabzevar Health Centers during 2017-2018. The subjects were randomly divided into two groups of intervention and control. The intervention group participated in childbirth preparation classes and the control group received only the routine prenatal care. Wijma Delivery Expectancy Questionnaire (W-DEQ) Version A&B was completed before and after the intervention and 14 days after delivery by the mothers. Data were analyzed by SPSS software (version 22) and t-test and Repeated Measurement Variance Analysis.  P<0.05 was considered statistically significant.
Results: The mean total score of questionnaire and all the factors except the fear of fetal injury were significantly higher in the intervention group than the control group (p <0.05). Also, the scores of all factors except fear of fetal injury increased in the intervention group from pre-test to post-test and follow-up (P <0.05). The scores of fear of fetal injury in the intervention group decreased in post-test while in the control group decreased after childbirth; comparison of means showed difference between two groups (p=0.01).
Conclusion: Childbirth preparation classes held in Sabzevar increased the fear of childbirth. Therefore, the content of this training course must be assessed.
Keywords
Childbirth
Fear
Postpartum
Pregnancy
Prenatal training
  1. Spaich S, Welzel G, Berlit S, Temerinac D, Tuschy B, Sütterlin M, et al. Mode of delivery and its influence on women's satisfaction with childbirth. Eur J Obstet Gynecol Reprod Biol 2013; 170(2):401-6.
  2. Heydarpour S, Zare E, Mehrabi E, Heidarpour F, Kolivand M. Comparison of primipara’s women perception of pain, fear and anxiety of vaginal delivery among persian, kurdish and turkish women. Journal of clinical research in paramedical sciences 2015; 4(3):223-230.
  3. Alipour Z, Lamyian M, Hajizadeh E, Vafaei MA. The association between antenatal anxiety and fear of childbirth in nulliparous women: a prospective study. Iran J Nurs Midwifery Res 2011; 16(2):169-73.
  4. Najafi F, Abouzari Gazafroodi K, Jafarzadeh Kenarsari F, Rahnama P, GHolami Chaboki B. Relationship between attendance at childbirth preparation classes and fear of childbirth and type of delivery. Hayat 2016; 21(4):30-40.
  5. Leeman LM, Plante LA. Patient-choice vaginal delivery? Ann Fam Med 2006; 4(3):265-268.
  6. Ghanbari V, Maddah SS, Khankeh HR, Karimloo M, Ardalan A. The Effect of a Disaster Nursing Education Program on Nurses’ Preparedness for Responding to Probable Natural Disasters. Iran Journal of Nursing 2011; 24(73):72-80.
  7. Shariat M, Majlesi F, Azari S, Mahmoudi M. Cesarean section in maternity hospitals in Tehran, Iran. Payesh 2002; 1(3):5-10.
  8. Andaroon N, Kordi M, Kimiaei SA, Esmaeili H. Relationship between Intensity of fear of Childbirth with choosing mode of delivery in Primiparous Women. Iran J Obstet Gynecol Infertil 2017; 20(5):68-75.
  9. Ryding EL, Wijma B, Wijma K, Rydhström H. Fear of childbirth during pregnancy may increase the risk of emergency cesarean section. Acta Obstet Gynecol Scand 1998; 77(5):542-7.
  10. Khorsandi M, Vakilian K, Nasir zadeh Masooleh M. Investigating Different Factors of Fear in Normal Delivery among Pregnant Women, in Arak-A Cross Sectional Study. J Fasa Univ Med Sci 2014; 4(2):161-167.
  11. O'Connell MA, O'Neill SM, Dempsey E, Khashan AS, Leahy‐Warren P, Smyth RMD, et al. Interventions for fear of childbirth (tocophobia). Cochrane Database of Systematic Reviews 2019; 5:CD013321.
  12. Jamilian M, Mobasseri SH, Wakilian K, Jamilian HR. Effect of childbirth prepartion classes on the duration of admission and satisfaction of mothers. Journal of Ilam University of Medical Sciences 2014; 21(2):44-50.
  13. Lederman RP, Lederman E, Work BA Jr, McCann DS. Relationship of psychological factors in pregnancy to progress in labor. Nurs Res 1979; 28(2):94-7.
  14. khavandizadeh Aghdam S, Mahfouzi Y, Kazemzadeh R. Effect of prenatal preparation classes on the duration of labor and delivery type in primiparous women. Iran J Obstet Gynecol Infertil 2019; 21(11):37-43.
  15. Rajabi Naeeni M, Simbar M. Effect of child birth preparation classes on empowering Iranian pregnant women: a systematic review. J Educ Community Health 2018; 5(1):61-71.
  16. Ghazaie M, Davoodi I, Neysi A, Mehrabizadeh Honarmand M, Bassak Nejad S. The effectiveness of cognitive-behavioral therapy on fear of childbirth, fear of pain, self-efficacy of childbirth and tendency to caesarean in nulliparous women. Iran J Obstet Gynecol Infertil 2016; 19(31):1-12.
  17. Sturrock WA, Johnson JA. The relationship between childbirth education classes and obstetric outcome. Birth 1990; 17(2):82-5.
  18. Rastegari L, Mohebbi P, Jafari E, Mazloumzadeh S. Effects of child birth preparation classes on parous women’s’ attitude toward child birth. Preventive care in nursing & midwifery journal 2016; 6(2):36-44.
  19. Najafi F, Abouzari-Gazafroodi K, Jafarzadeh-Kenarsari F, Rahnama P, Gholami Chaboki B. Relationship between attendance at childbirth preparation classes and fear of childbirth and type of delivery. Hayat 2016; 21(4):30-40.
  20. Sharifzadeh M, Bolbol Haghighi N, Keramat A, Goli M, Motaghi Z. Effectiveness of midwifery counseling based on solution-focused approaches on fear of childbirth. koomesh 2018; 20(2):375-83.
  21. Toohill J, Fenwick J, Gamble J, Creedy DK, Buist A, Ryding EL. A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women. Birth 2014; 41(4):384-394.
  22. Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG 2009; 116(9):1167-76.
  23. Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ: a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynecol 1998;19(2):84-97.
  24. Wijma K, Alehagen S, Wijma B. Development of the Delivery Fear scale. J Psychosom Obstet Gynecol 2002; 23(2):97-107.
  25. Mortazavi F. Validity and reliability of the Farsi version of Wijma delivery expectancy questionnaire: an exploratory and confirmatory factor analysis. Electron Physician 2017; 9(6):4606-15.
  26. Fontein-Kuipers YJ, Nieuwenhuijze MJ, Ausems M, Budé L, de Vries R. Antenatal interventions to reduce maternal distress: a systematic review and meta-analysis of randomised trials. BJOG 2014; 121(4):389-97.
  27. Haapio S , Kaunonen M, Arffman M, Åstedt-Kurki P. Effects of extended childbirth education by midwives on the childbirth fear of first‐time mothers: an RCT. Scand J Caring Sci 2017; 31(2):293-301.
  28. Fathizadeh M, Abedini S, Mohseni S. The effect of childbirth preparation courses on the reduction of anxiety of pregnant women referring to health centers of sirik in hormozgan, iran. PCNM 2016; 6(3):24-33.
  29. Fabian HM, Rådestad IJ, Waldenström U. Childbirth and parenthood education classes in Sweden. Women's opinion and possible outcomes. Acta Obstet Gynecol Scand 2005; 84(5):436-43.
  30. Guszkowska M. The effect of exercise and childbirth classes on fear of childbirth and locus of labor pain control. Anxiety Stress Coping 2014; 27(2):176-89.
  31. Toohill J, Fenwick J, Gamble J, Creedy DK, Buist A, Turkstra E, et al. A randomized controlled trial of a psycho‐education intervention by midwives in reducing childbirth fear in pregnant women. Birth 2014; 41(4):384-394.
  32. Fenwick J, Toohill J, Gamble J, Creedy DK, Buist A, Turkstra E, et al. Effects of a midwife psycho-education intervention to reduce childbirth fear on women’s birth outcomes and postpartum psychological wellbeing. BMC Pregnancy Childbirth 2015; 15:284.
  33. Salmela-Aro K, Read S, Rouhe H, Halmesmäki E, Toivanen RM, Tokola MI, et al. Promoting positive motherhood among nulliparous pregnant women with an intense fear of childbirth: RCT intervention. J Health Psychol 2012; 17(4):520-34.
  34. Rouhe H, Salmela‐Aro K, Gissler M, Halmesmäki E, Saisto T. Mental health problems common in women with fear of childbirth. BJOG 2011; 118(9):1104-11.
  35. Ghazaie M, Davoodi I, Neysi A, Mehrabizadeh Honarmand M, Bassak Nejad S. The effectiveness of cognitive-behavioral therapy on fear of childbirth, fear of pain, self-efficacy of childbirth and tendency to caesarean in nulliparous women. Iran J Obstet Gynecol Infertil 2016; 19(31):1-12.
  36. Asefi F, Delaram M, Kazemian A, Bahadoran P. The effect of pregnant women attending in delivery preparation classes on their attitudes mode of delivery. Journal of Clinical Nursing and Midwifery 2016; 5(3):44-52.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 23, Issue 1
March 2020
Pages 58-68