Childbirth Experience -Psychological,Cultural and Medical Associations

This study was carried out in Beer Sheva, Israel on 200 Jewish women. The women were interviewed twice; several weeks before delivery at the ‘antenatal care’ clinic, and within 48 h of delivery.

The questionnaire included socio-demographic information, past obstetric history, questions on previous births and expectations from the present birth. Anxiety was measured before and after delivery by the ‘State and Trait Anxiety Inventory’ compiled by Spielberger. The questionnaire used after delivery included obstetric data and questions concerning the woman's perception of the childbirth experience.

The findings of this study indicated that higher anxiety state and trait before birth associated significantly to a negative childbirth experience. Some factors like lack of explanation on childbirth and multiparity were shown to be associated with higher anxiety states before labour, while other factors that were found to have an important effect on the perception of childbirth as a negative experience were: (1) previous negative birth experience (P = 0.025); (2) abnormal deliveries (vacuum, forceps, cesarean section, P < 0.01); and (3) ethnic origin (P < 0.01).

According to our study, thorough explanation of what happens during pregnancy and labour which would be considered clear and satisfactory by the expectant mother, as well as more attention and support given to multiparous pregnant women, might positively influence the childbirth experience, directly or indirectly by reducing anxiety state.     

Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health

Objective

to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear.

Design

a longitudinal regional survey. Data were collected by three questionnaires.

Setting

three hospitals in the middle-north part of Sweden.

Participants

1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth.

Measurements

childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear).

Findings

expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2–2.8) and mental (OR 3.0; 1.8–5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4–3.0), and the forthcoming birth (OR 4.3; 2.9–6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience.

Key conclusions

expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress.

Implications for practice

this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.     

Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process

Objective: This study determined the effect of an educational program based on cognitive behavioral techniques (CBT) provided for pregnant women to address their fear of childbirth.

Methods: This study was conducted experimentally using pretest–posttest and a control group. A total of 111 Turkish pregnant women were recruited with 52 in the intervention group and 59 in the control group. The intervention group attended the educational program on coping with childbirth fears based on CBT, which took 3?weeks over six sessions. The Wijma Delivery Expectancy/Experience Questionnaire, version-A (W-DEQ-A) was administered to both groups as the posttest. The researchers monitored the pregnant women’s labor and delivery and the State Anxiety Inventory (SAI), Numeric Pain Rating Scale (NPRS) and Birth Process Evaluation Form were completed.

Results: The post-education W-DEQ-A score was 63.5 in the control group and 39.4 in the intervention group (p?<?.001). Their labor pain was lower, the second stage of labor was shorter and birth was more satisfactory for the intervention group than for the control group (p?<?.05). The CBT-based educational program and pain severity during childbirth were the significant predictors of satisfaction with childbirth (β?=?0.354; β?=?–0.324, respectively; p?<?.05 for all).

Conclusions: The CBT-based educational program on coping with childbirth fears reduced pregnant women's fear of childbirth and positively affected their birth experience.     

Outcomes of Father Involvement in Pregnancy and Birth

: To test the assumption that father involvement in pregnancy and childbirth results in more positive birth and fathering experiences, 40 primiparous couples recruited from childbirth education classes and obstetricians were studied. About two weeks before their due dates each mother was asked to rate her marital closeness and her husband's interest in children. These couples were observed for one hour in mid-labor. Then mothers and fathers were interviewed about one week after the birth. Fathers who were more involved in terms of their wives’ reports of prenatal marital closeness gave generally more positive reports of the delivery and the new baby. Fathers who were involved in terms of their wives’ estimates of their interest in children were rated by observers as interacting with their wives less during labor. (BIRTH 10:1, Spring 1983)     

Women’s acute anxiety variations before and after epidural anesthesia for childbirth

Objective: This study assessed changes in anxiety during different phases of childbirth in a sample of women demanding epidural anesthesia.

Design: Prospective, longitudinal case series.

Sample: A total of 133 women who demanded epidural anesthesia for childbirth answered the questionnaires.

Methods: Anxiety state was measured using the State Trait Anxiety Inventory (STAI) questionnaire. The STAI-S (anxiety state) was administered in three phases during childbirth: Phase 1 was before applying epidural anesthesia, Phase 2 was 45?min after the application of epidural anesthesia and Phase 3 was at less than 24?h after delivery. Data were collected in two general hospitals: a third-level public hospital and a well-recognized private hospital.

Main outcome measures: STAI scores.

Results: Anxiety state decreases significantly after applying the epidural anesthesia (Phase 2) compared to before anesthesia (Phase 1), and it remains low levels 24?h after childbirth (Phase 3). There were statistically significant differences in STAI scores between the different phases administrated (Phases 1 and 2: p?d?=?1.40; Phases 1 and 3: p?d?=?1.39). In Phase 3, women with cesarean section birth had significant differences in STAI scores relative to those with spontaneous birth (p?=?0.037; d?=?0.44). The type of health-care setting (public or private), the educational level and the numbers of previous births does not affect the level of anxiety state in women in any of the three phases.

Conclusions: Women’s anxiety decreases significantly after applying epidural anesthesia, and it remains low 24?h after delivery. Anxiety against childbirth was not influenced by the health system used by women, by the condition of primiparous or multiparous, or by the educational level. Women who received an epidural anesthesia with a cesarean section reported higher rates of anxiety state after birth.     

FIRST-TIME FATHERS' CHILDBIRTH EXPERIENCE

Twenty first-time fathers who had attended prenatal classes were interviewed before and after attending their wives' childbirth to determine the father's special needs at this time. The same fifty-item questionnaire was utilized in both the predelivery and the postdelivery interviews. Motivation for involvement in childbirth was explored in the predelivery interview. The most frequent motivations for involvement in childbirth were “to share the birth,” and “to enhance the couple relationship.” The responses differed little in the pre- and postdelivery interviews. In the postdelivery interview, more fathers wanted to know the baby's condition as soon as possible after birth and wanted to have the nurse at their wives' bedside as much as possible during labor. Most of the fathers had high needs for understanding, nurturance, and deference during labor. Most fathers wanted the nurses to take care of their emotional needs rather than their physical needs (hunger and rest). Assisting their wives in labor was considered to be a great achievement by the fathers. Few fathers felt overpowered or anxious about the environment of the labor suite or the birth itself. This study concluded that further research with fathers who do not attend prenatal classes was needed.     

Mediating Role of Labor on the Relationship Between Prenatal Psychopathologic Symptoms and Symptoms of Postpartum Depression in Women Who Give Birth Vaginally

ObjectiveTo investigate how prenatal symptoms of anxiety and depression and clinical aspects of labor (duration of labor, administration of oxytocin and epidural analgesia) interact with each other to contribute to symptoms of postpartum depression in women who give birth vaginally.DesignA longitudinal design with measurement at three different time points: Time 1, 31 to 32 weeks gestation; Time 2, the day of labor and birth; and Time 3, 1 month after birth.SettingMaternity ward of the Misericordia e Dolce Hospital in Prato, Italy.ParticipantsA total of 186 women at 31 to 32 weeks gestation were recruited during childbirth preparation courses at the maternity ward.MethodsAt Time 1, women completed the Beck Depression Inventory and the State portion of the State–Trait Anxiety Inventory. At Time 2, midwives recorded clinical data related to labor, including duration of labor and administration of oxytocin and epidural analgesia. At Time 3, the women completed the Edinburgh Postnatal Depression Scale. Structural equation modeling was performed.ResultsSymptoms of depression (β = 0.36; p < .001; 95% confidence interval [CI] [0.17, 0.49]) and state anxiety (β = 0.25; p < .001; 95% CI = [0.04, 0.27]) during pregnancy positively affected symptoms of depression after birth. Greater levels of these prenatal symptoms predicted a more complicated labor (depression: β = 0.29; p < .01; 95% CI [0.00, 0.19]; anxiety: β = 0.30; p < .01; 95% CI [0.01, 0.14]), which, in turn, positively predicted greater levels of symptoms of depression at 1 month after birth (β = 0.34; p < .001; 95% CI [0.38, 1.51]). Moreover, results highlighted indirect effects that high levels of anxiety symptoms during pregnancy have on postpartum symptoms of depression through the clinical aspects of labor (β = 0.10; p < .01; 95% CI [0.00, 0.13]). These indirect effects were not significant for antenatal symptoms of depression (β = 0.10; p < .05; 95% CI [–0.02, 0.20]).ConclusionOur findings confirm that symptoms of anxiety and depression during pregnancy represent significant risk factors for the clinical aspects of labor and for the development of symptoms of postpartum depression in the first month after childbirth.     

Using Music During Childbirth

Background: The application of music in pain management has become popular in the past two decades. This article describes the responses of primiparas to the use of music therapy during the births of their children. Method: Eleven women who attended childbirth education classes in Brantford, Ontario, Canada, volunteered to participate in a music therapy exercise. During pregnancy each participant selected preferred music, listened to it daily, and received instruction about focused listening. Within 72 hours after birth they were interviewed about their use of music as a coping strategy during labor. Results: Women selected the combination of music and labor support as a helpful coping strategy during labor. All women used the music during labor to help distract them from the pain or their current situation. Conclusion: The planned use of music by mothers and caregivers can be an aid to prenatal preparation and an important adjunct in pain and stress management during labor and birth.     

Birth place preferences and women’s expectations and experiences regarding duration and pain of labor

Introduction: We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women.

Methods: A prospective cohort study (2007–2011) of 454 women who preferred a home birth (n?=?179), a midwife-led hospital birth (n?=?133) or an obstetrician-led hospital birth (n?=?142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth.

Results: Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2–0.9) and were less likely to expect difficulties with coping with pain (OR 0.4, 95%CI 0.2–0.8) compared with women who preferred an obstetrician-led birth. We found no significant differences in postpartum accounts of duration of labor. When compared to women who preferred an obstetrician-led birth, women who preferred a home birth were significantly less likely to experience labor pain as unpleasant (OR 0.3, 95%CI 0.1–0.7). Women who preferred a midwife-led birth – either home or hospital – were more likely to report that it was not possible to make their own choices regarding pain relief compared to women who preferred obstetrician-led care (OR 4.3, 95%CI 1.9–9.8 resp. 3.4, 95%CI 1.5–7.7). Compared to women who preferred a midwife-led hospital birth, women who preferred a home birth had an increased likelihood of being dissatisfied about the management of pain relief (OR 2.5, 95%CI 1.1–6.0).

Discussion: Our findings suggest a more natural orientation toward birth with the acceptance of labor pain as part of giving birth in women with a preference for a home birth. Knowledge about women’s expectations and experiences will help caregivers to prepare women for childbirth and will equip them to advise women on birth settings that fit their cognitive frame.     

Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study

Objective

to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors.

Design

a regional cohort study. Data was collected by a questionnaire.

Setting

three hospitals in the middle-north part of Sweden

Participants

1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS).

Measurements

prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers.

Findings

the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2–5.2), country of birth other than Sweden (OR 2.8; 1.3–6.1), a preference for a caesarean birth (OR 2.1; 1.7–4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1–2.0) and expecting the first baby (OR 1.8; 1.2–2.6).

Key conclusions

high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth.

Implications for practice

engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.     

Fathers' Coping Style,Antenatal Preparation,and Experiences of Labor and the Postpartum

Background: In recent years the trend for fathers in Western postindustrial countries to attend childbirth has increased. This study examined the interaction between fathers' information‐seeking coping predispositions and their level of attendance at antenatal classes with respect to their experiences of attending childbirth. Associations between fathers' childbirth experiences, their relationship with their baby, and level of depressive symptomatology at 6 weeks postpartum were also examined. Methods: A quantitative methodology was employed in which 78 fathers completed several questionnaires, some within 6 days of childbirth and others at 6 weeks postpartum. Results: Fathers who were characterized as high blunters (avoiders) of threat information, from antenatal classes reported that experiencing childbirth was less fulfilling than fathers with similar coping styles who did not attend classes. Fathers' reports of fulfillment and delight while attending childbirth were negatively related to their level of depressive symptomatology at 6 weeks postpartum. Levels of distress were associated with subsequent depressive symptoms, but their effect was removed when preexisting depressive symptoms were partialled out. Fathers whose children were born by cesarean delivery used significantly more negative adjectives to describe their baby at 6 weeks postpartum compared with those born by vaginal delivery. More married fathers attended antenatal classes and reported lower levels of depressive symptomatology than unmarried fathers. Conclusions: Although fathers' attendance at antenatal classes may have positive consequences for them and their partner, for some fathers, attendance at classes may be associated with less positive reports of experiencing childbirth. The way in which men experience childbirth may have some influence on their subsequent emotional well‐being.     

Childbirth Education Classes: Expectant Parents''Expectations

One hundred clients (43 fathers, 57 mothers), of whom 50 had enrolled in childbirth education classes but had not yet attended and 50 who had attended and were parents of a healthy infant, were surveyed to find out what clients expect to gain from attending childbirth education classes. Responses of preclass and postdelivery male and female clients were compared using content analysis and chi-square statistics. Results suggest that interest followed pregnancy chronology, fathers expected to learn facts, mothers expected to learn coping strategies, and both expected to learn breathing, relaxation, and infant care techniques. Although clients felt that more time should have been spent on the majority of topics, 64% of mothers and 53% of fathers said that the classes had met their expectations.     

Afterpains: A Comparison Between Active and Expectant Management of the Third Stage of Labor

Abstract: Background: Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare women’s experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains. Methods: A single‐blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women (n = 1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain‐o‐Meter (POM‐WDS) 2 hours after delivery of the placenta and the day after childbirth. Results: At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women (p = 0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management (p < 0.001). Conclusions: Active management of the third stage of labor does not provoke more intense afterpains than expectant management. (BIRTH 38:4 December 2011)     

The impact of maternal nausea and vomiting in pregnancy on expectant fathers: findings from the Australian Fathers’ Study

Introduction: Nausea and vomiting in pregnancy (NVP) are common. Whilst the impact on pregnant women has been well documented, there is less data on the impact on partners. This study evaluated awareness and impact of maternal NVP on expectant fathers.

Methods: Observational study of 300 expectant fathers. Institutional ethics approval and consent were obtained. Fathers were recruited from antenatal clinics and community settings. Researchers administered demographic, attitudinal and the Hospital Anxiety and Depression scale questionnaires during the third trimester. Expectant fathers were asked if their partner experienced NVP. If aware, they were asked to comment upon the impact on their lives.

Results: Participants were similar in demographics to those of the wider Australian community of expectant fathers. Most fathers were aware whether their partner experienced NVP (82%). Of these fathers, 20% reported no NVP, and 30%, 37% and 13% men reported maternal NVP was mild, moderate and severe, respectively. There was no correlation between paternal depression and maternal NVP, but a significant association was found between moderate and severe maternal NVP and paternal anxiety. In qualitative comments, five themes emerged: disruption on work, feelings of frustration and helplessness, concern over depression in their partner, concern for the developing baby and a sense of being manipulated in the third trimester of pregnancy.

Discussion: Most expectant fathers are aware of NVP in their partner. Moderate and severe maternal NVP are associated with significantly higher symptoms of paternal anxiety.     

Anxiety assessment in parturients requesting epidural analgesia for pain relief

OBJECTIVES: Neuraxial methods provide the most effective labor pain relief. This study aimed at assessing anxiety level in parturients requesting epidural analgesia (EA). MATERIAL AND METHODS: Forty five women in spontaneous, active labor were enrolled, both primiparas (n=36) and multiparas (n=9). Anxiety was assessed by means of Spielberger State and Trait Anxiety Inventory (STAI) before administration of EA, and pain was measured by visual-analog scale (VAS) before and after analgesia. RESULTS: In all the studied parturients state anxiety was strikingly higher than the trait (53.9 +/- 11.8 vs. 39.3 +/- 8.4; P < 0.0001); the difference appeared insignificant in multiparas only. State anxiety was comparable independently of parity, labor outcome and systemic opioid administration. No association between anxiety level and labor pain intensity preceding analgesia, the duration of labor stages and demographic parameters could be found. However, a negative correlation between state anxiety and pain intensity reported after EA administration was noted (R = -0.315, p = 0.040), and, in cases of physiological labor, a negative association between state anxiety and the neonate Apgar score at the 1st minute after birth could be observed (R = -0.337, p = 0.047, Spearman rank test). CONCLUSIONS: In parturients requesting EA, state anxiety level is increased and not connected with the trait. Furthermore, in these women, anxiety appears not to be associated with labor pain but may influence the analgesic effect of the blockade. Anxiety does not determine labor duration and outcome; however, it may be connected with the well-being of the neonate immediately after birth.     

Childbirth Experiences in Australia of Women Born in Turkey,Vietnam, and Australia

ABSTRACT: Background: Migrant women constitute a growing proportion of the childbearing population in many high‐income countries. The aim of this study was to investigate experiences of childbirth, including recollection of pain and use of pain relief, in women born in Vietnam, Turkey, and Australia who gave birth in Victoria, Australia. Methods: One hundred Vietnamese‐born and 100 Turkish‐born women were compared with 100 Australian‐born women who gave birth in the same metropolitan hospital during the same time period. Only women who had a normal vaginal birth and gave birth to a healthy baby were included. They were interviewed between 24 hours after the birth and hospital discharge. Results: Vietnamese women used less pain relief, reported more pain, and described childbirth overall more negatively than Australian women, while also reporting less anxiety, more confidence, and less panic during labor. Turkish women's responses were more similar to those of Australian women, but they were slightly more satisfied with childbirth overall despite recollecting more pain, and were also more likely to perceive time normally. Turkish women used a similar amount of pharmacological pain relief as Australian women, but used more relaxation and breathing techniques. Conclusions: This study showed that women's responses to childbirth are associated with cultural background. Midwives and other caregivers should be particularly sensitive in assessing Vietnamese women's pain during labor. (BIRTH 32:4 December 2005)     

First-time fathers' expectations and experiences of childbirth in relation to age

Objective

to investigate first-time fathers' expectations and experiences of childbirth and satisfaction with care in relation to paternal age.

Design

data from a randomised controlled trial of antenatal education were used for secondary analysis. Data were collected by questionnaires in mid-pregnancy and at three months after the birth. Comparisons by χ²-tests and Student's t-tests were made between men in three age groups: young men aged ≤27 years (n=188), men of average age 28–33 years (n=389) and men of advanced age ≥34 years (n=200).

Setting

the expectant fathers were recruited from 15 antenatal clinics spread over Sweden.

Participants

777 first-time fathers.

Findings

antenatal expectations and postnatal memory of the childbirth experience varied by paternal age. In mid-pregnancy, mixed or negative feelings about the upcoming birth were more prevalent in men of advanced age (29%) compared with men of average (26%) and young (18%) age (p<0.01), and they feared the event more than the youngest (mean on the Wijma Delivery Expectancy Questionnaire: advanced age 43.3; average age 42.9; young 38.7; p<0.01). The older men also assessed their partner's labour and birth as more difficult (advanced age 43%; average age 41%; young 32%; p=0.05) and had a less positive overall birth experience (advanced age 30%; average age 36%; young 43%; p<0.05). However, older fathers were more satisfied with care given during the intrapartum period: 52% were overall satisfied compared with 46% of the men of average age and 39% of young age (p=0.03).

Key conclusions

men of advanced age had more fearful and negative expectations during their partner's pregnancies and postnatally assessed the births as less positive and more difficult than younger men did. Despite this, older men were more satisfied with intrapartum care.

Implications for practice

knowledge about age-related differences in the expectations and experiences of first-time fathers may help midwives and doctors give more individualised information and support, with special attention to older men's expectations and experiences of the birth as such, and to younger men's perception of care.