Abstract
Background: Fear of childbirth (FOC) is considered one of the factors influencing the increase in elective cesarean section. The appropriate solution to reduce the FOC has not yet been identified.
Objective: The present study aimed to evaluate the effect of haptonomy intervention on FOC and maternal- fetal attachment (MFA) among primigravid women.
Methods: This quasi-experimental study was conducted on 68 primigravid women with a gestational age of 24-28 weeks who were referred to health centers in Tabriz, Iran, with a FOC score above 65. Participants were randomly assigned to the intervention and control groups. The intervention group (n=34) received haptonomy in 5 sessions, once a week for 45-60 minutes, and the control group received an information pamphlet about pain management options in labor and fetal development during pregnancy. The data were collected using Wijma Delivery Expectancy/Experience Questionnaireversion A, Cranley’s MFA Scale, and Revised Pregnancy Related Anxiety Questionnaire, before the intervention and at a gestational age of 35-37 weeks. The data were analyzed using Chi-square, independent t-test, and ANCOVA.
Results: After intervention and controlling the effect of baseline score, the mean score of FOC in the intervention group was significantly lower than that in the control group [Adjusted mean difference (AMD): -23.67, 95% CI: - 28.12 to -19.23, p = 0.001]. Further, the mean score of MFA indicated a significant difference between the two groups [AMD: 10.12, 95% CI: 6.44 to 13.8, p <0.001].
Conclusion: The results of the present study revealed the effectiveness of the haptonomy intervention in reducing FOC and increasing MFA. Therefore, the use of haptonomy intervention is recommended among mothers with high and severe FOC and low MFA.
Graphical Abstract
[1]
Handelzalts JE, Becker G, Ahren MP, et al. Personality, fear of childbirth and birth outcomes in nulliparous women. Arch Gynecol Obstet 2015; 291(5): 1055-62.
[http://dx.doi.org/10.1007/s00404-014-3532-x] [PMID: 25391637]
[http://dx.doi.org/10.1007/s00404-014-3532-x] [PMID: 25391637]
[2]
Nilsson C, Hessman E. Sjöblom H, et al. Definitions, measurements and prevalence of fear of childbirth: A systematic review. BMC Pregnancy Childbirth 2018; 18(1): 28.
[http://dx.doi.org/10.1186/s12884-018-1659-7] [PMID: 29329526]
[http://dx.doi.org/10.1186/s12884-018-1659-7] [PMID: 29329526]
[3]
Sanjari S, Chaman R, Salehin S, Goli S, Keramat A. Update on the global prevalence of severe fear of childbirth in low-risk pregnant women: A systematic review and meta-analysis. Int J Women’s Health Reprod Sci 2021; 10(1): 3-10.
[http://dx.doi.org/10.15296/ijwhr.2022.02]
[http://dx.doi.org/10.15296/ijwhr.2022.02]
[4]
Mortazavi F, Mehrabadi M. Predictors of fear of childbirth and normal vaginal birth among Iranian postpartum women: A cross-sectional study. BMC Pregnancy Childbirth 2021; 21(1): 316.
[http://dx.doi.org/10.1186/s12884-021-03790-w] [PMID: 33882872]
[http://dx.doi.org/10.1186/s12884-021-03790-w] [PMID: 33882872]
[5]
Adeli Gargari M, Esmailpour K, Mirghafourvand M, Nourizadeh R, Mehrabi E. Effects of psycho-education interventions on perceived childbirth fear and anxiety by pregnant women: A systematic review and meta-analysis. Int J Women’s Health Reprod Sci 2020; 9(4): 230-7.
[http://dx.doi.org/10.15296/ijwhr.2021.44]
[http://dx.doi.org/10.15296/ijwhr.2021.44]
[6]
Nath A, Venkatesh S, Balan S, Metgud CS, Krishna M, Murthy GVS. The prevalence and determinants of pregnancy-related anxiety amongst pregnant women at less than 24 weeks of pregnancy in Bangalore, Southern India. Int J Womens Health 2019; 11: 241-8.
[http://dx.doi.org/10.2147/IJWH.S193306] [PMID: 31114392]
[http://dx.doi.org/10.2147/IJWH.S193306] [PMID: 31114392]
[7]
Ossa X, Bustos L, Fernandez L. Prenatal attachment and associated factors during the third trimester of pregnancy in Temuco, Chile. Midwifery 2012; 28(5): e689-96.
[http://dx.doi.org/10.1016/j.midw.2011.08.015] [PMID: 21955858]
[http://dx.doi.org/10.1016/j.midw.2011.08.015] [PMID: 21955858]
[8]
Wall V, Premji SS, Letourneau N, McCaffrey G, Nyanza EC. Factors associated with pregnancy-related anxiety in Tanzanian women: A cross sectional study. BMJ Open 2018; 8(6): e020056.
[http://dx.doi.org/10.1136/bmjopen-2017-020056] [PMID: 29866722]
[http://dx.doi.org/10.1136/bmjopen-2017-020056] [PMID: 29866722]
[9]
Sun Y, Huang K, Hu Y, et al. Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLoS One 2019; 14(5): e0216870.
[http://dx.doi.org/10.1371/journal.pone.0216870] [PMID: 31091276]
[http://dx.doi.org/10.1371/journal.pone.0216870] [PMID: 31091276]
[10]
Alimohamadian M, Shariat M, Mahmoodi M, Ramezanzadeh F. The influence of maternal request on the elective cesarean section rate in maternity hospitals in Tehran, Iran. Payesh 2003; 2(2): 137-42.
[11]
Sandall J, Tribe RM, Avery L, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet 2018; 392(10155): 1349-57.
[http://dx.doi.org/10.1016/S0140-6736(18)31930-5] [PMID: 30322585]
[http://dx.doi.org/10.1016/S0140-6736(18)31930-5] [PMID: 30322585]
[12]
O’Connell MA, Khashan AS, Leahy-Warren P, et al. Interventions for fear of childbirth including tocophobia. Cochrane Database Syst Rev 2021; 7: CD013321.
[PMID: 34231203]
[PMID: 34231203]
[13]
Souto SPA, de Albuquerque RS, Silva RCG, Guerra MJ, Prata AP. Midwife interventions to reduce fear of childbirth in pregnant women: A scoping review protocol. JBI Evidence Synthesis 2020; 18(9): 2045-57.
[http://dx.doi.org/10.11124/JBISRIR-D-19-00198] [PMID: 32813435]
[http://dx.doi.org/10.11124/JBISRIR-D-19-00198] [PMID: 32813435]
[14]
O’Connell MA, Khashan AS, Leahy-Warren P. Women’s experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence. Women Birth 2021; 34(3): e309-21.
[http://dx.doi.org/10.1016/j.wombi.2020.05.008] [PMID: 32522443]
[http://dx.doi.org/10.1016/j.wombi.2020.05.008] [PMID: 32522443]
[15]
Klabbers GA, Wijma K, Paarlberg KM, Emons WHM, Vingerhoets AJJM. Haptotherapy as a new intervention for treating fear of childbirth: A randomized controlled trial. J Psychosom Obstet Gynaecol 2019; 40(1): 38-47.
[http://dx.doi.org/10.1080/0167482X.2017.1398230] [PMID: 29157055]
[http://dx.doi.org/10.1080/0167482X.2017.1398230] [PMID: 29157055]
[17]
Paica CI. Prenatal and postnatal psychological counselling the conscious assumption of the maternal role. J Experient Psychother 2017; 20(2): 24-31.
[18]
Ozbek H, Pinar SE. The effect of haptonomy applied to pregnant women on perceived stress, fear of childbirth, and prenatal attachment: randomized controlled experimental study. Curr Psychol 2022; 1-10.
[http://dx.doi.org/10.1007/s12144-022-03388-1] [PMID: 35874964]
[http://dx.doi.org/10.1007/s12144-022-03388-1] [PMID: 35874964]
[19]
Khorsandi M, Ghofranipour F, Heydarnia A. The effect of childbirth preparation classes on childbirth fear and normal delivery among primiparous women. J Arak Univ Med Sci 2008; 11(3): 29-36.
[20]
Akbarzadeh M, Toosi M, Zare N, Sharif F. Effect of learning attachment behaviors on anxiety and maternal fetal attachment in first pregnant women. Evid Based Care J 2011; 1(1): 21-34.
[21]
Hilgers RD, Manolov M, Heussen N, Rosenberger WF. Design and analysis of stratified clinical trials in the presence of bias. Stat Methods Med Res 2020; 29(6): 1715-27.
[http://dx.doi.org/10.1177/0962280219846146] [PMID: 31074333]
[http://dx.doi.org/10.1177/0962280219846146] [PMID: 31074333]
[22]
Probst P, Grummich K, Heger P, et al. Blinding in randomized controlled trials in general and abdominal surgery: Protocol for a systematic review and empirical study. Syst Rev 2016; 5(1): 48.
[http://dx.doi.org/10.1186/s13643-016-0226-4] [PMID: 27012940]
[http://dx.doi.org/10.1186/s13643-016-0226-4] [PMID: 27012940]
[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 Gynaecol 1998; 19(2): 84-97.
[http://dx.doi.org/10.3109/01674829809048501] [PMID: 9638601]
[http://dx.doi.org/10.3109/01674829809048501] [PMID: 9638601]
[24]
Abedi P, Hazeghi N, Afshari P, Fakhri A. The validity and reliability of persian version of Wijma delivery expectancy/experience questionnaire (version A) among Iranian Nulliparous women. Glob J Health Sci 2016; 9(2): 269.
[http://dx.doi.org/10.5539/gjhs.v9n2p269]
[http://dx.doi.org/10.5539/gjhs.v9n2p269]
[25]
Cranley MS. Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 1981; 30(5): 281-4.
[http://dx.doi.org/10.1097/00006199-198109000-00008] [PMID: 6912989]
[http://dx.doi.org/10.1097/00006199-198109000-00008] [PMID: 6912989]
[26]
Huizink AC, Menting B, Oosterman M, Verhage ML, Kunseler FC, Schuengel C. The interrelationship between pregnancy-specific anxiety and general anxiety across pregnancy: A longitudinal study. J Psychosom Obstet Gynaecol 2014; 35(3): 92-100.
[http://dx.doi.org/10.3109/0167482X.2014.944498] [PMID: 25093467]
[http://dx.doi.org/10.3109/0167482X.2014.944498] [PMID: 25093467]
[27]
Bayrampour N, Nourizadeh R, Mirghafourvand M, Mehrabi E, Mousavi S. Psychometric properties of the pregnancy-related anxiety questionnaire-revised2 among Iranian women. Crescent J Med Biol Sci 2019; 6(3): 369-74.
[28]
van Swaay A, Vissers K, Engels Y, Groot M. Haptotherapy for patients with cancer; experience of haptotherapists and reasons for consultation: A survey among haptotherapists. Complement Ther Clin Pract 2021; 43: 101352.
[http://dx.doi.org/10.1016/j.ctcp.2021.101352] [PMID: 33761431]
[http://dx.doi.org/10.1016/j.ctcp.2021.101352] [PMID: 33761431]
[29]
Toohill J, Fenwick J, Gamble J, et al. A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women. Birth 2014; 41(4): 384-94.
[http://dx.doi.org/10.1111/birt.12136] [PMID: 25303111]
[http://dx.doi.org/10.1111/birt.12136] [PMID: 25303111]
[30]
Tata N. The effect of counseling with Beck’s cognitive therapy on anxiety and childbirth fear: a randomized controlled clinical trial MSc thesis in Midwifery, Faculty of Nursing and Midwifery. Iran: Tabriz University of Medical Sciences 2019.
[31]
Klabbers GA, Paarlberg KM, Vingerhoets AJJM. Does haptotherapy benefit mother-child bonding in women with high fear of childbirth? Int J Haptonom Haptother 2018; 3(1): 1-7.
[32]
Ekrami F, Mohammad-Alizadeh CS, Babapour KJ, Mirghafourvand M. Effect of counseling on maternal-fetal attachment in women with unplanned pregnancy: A randomized controlled trial. J Reprod Infant Psychol 2020; 38(2): 151-65.
[http://dx.doi.org/10.1080/02646838.2019.1636943] [PMID: 31274007]
[http://dx.doi.org/10.1080/02646838.2019.1636943] [PMID: 31274007]
[33]
Hopkins J, Miller JL, Butler K, Gibson L, Hedrick L, Boyle DA. The relation between social support, anxiety and distress symptoms and maternal fetal attachment. J Reprod Infant Psychol 2018; 36(4): 381-92.
[http://dx.doi.org/10.1080/02646838.2018.1466385] [PMID: 29727202]
[http://dx.doi.org/10.1080/02646838.2018.1466385] [PMID: 29727202]
[34]
Pisoni C, Garofoli F, Tzialla C, et al. Risk and protective factors in maternal–fetal attachment development. Early Hum Dev 2014; 90(S2): S45-6.
[http://dx.doi.org/10.1016/S0378-3782(14)50012-6] [PMID: 25220127]
[http://dx.doi.org/10.1016/S0378-3782(14)50012-6] [PMID: 25220127]
[35]
Bonacquisti A, Geller PA, Patterson CA. Maternal depression, anxiety, stress, and maternal-infant attachment in the neonatal intensive care unit. J Reprod Infant Psychol 2020; 38(3): 297-310.
[http://dx.doi.org/10.1080/02646838.2019.1695041] [PMID: 31795733]
[http://dx.doi.org/10.1080/02646838.2019.1695041] [PMID: 31795733]
[36]
Kordi M, Andaroon N, Kimiaei S, Esmaeily H. The effect of individual counseling program by a midwife on fear of childbirth in primiparous women. J Educ Health Promot 2017; 6(1): 97.
[http://dx.doi.org/10.4103/jehp.jehp_172_16] [PMID: 29296598]
[http://dx.doi.org/10.4103/jehp.jehp_172_16] [PMID: 29296598]
