Identifying and explaining experiences of fear of childbirth and coping strategies: A qualitative study

Author

Islamic Azad University, Zanjan Branch,

Abstract

Background and Objectives: Fear of childbirth is a natural response that helps women prepare for childbirth. However, if fear is increased, it can lead to physical and emotional disabilities. This study aims to explain the experiences of fear of childbirth and, consequently, present a model for reducing such fears.
Methods: A phenomenological approach was used in this study. The participants were selected from among primigravida (women who were pregnant for the first time) through purposeful sampling, and the data were collected through open and unstructured interviews. Besides, the collected data were analyzed using Colaizzi’s nine-stage method.
Results: Different types of fear of childbirth identified in this study were harmful to maternal and neonatal health, normal childbirth, the feeling of inability, and cesarean section. Besides, the reasons behind fear of childbirth were inadequate awareness, lack of trust in medical staff, negative experiences from information sources, and the environment of the maternity center. Finally, the most important strategies to deal with the fear of childbirth were faith in God, feeling confident, receiving support, raising awareness, and positive thinking which were used to design the model.
Conclusion: The findings of the study showed that women's self-confidence plays a key role in decreasing fear of childbirth. Therefore, effective measures should be taken to increase women's sense of self-confidence to reduce their fear of childbirth.

Keywords


1. Nilsson C, Hessman E, Sjöblom H, Dencker A, Jangsten E, Mollberg M, et al. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy and Childbirth. 2018; 18(1):28. 2. Fisher C, Hauck Y, Fenwick J. How social context impacts on women's fears of childbirth: A Western Australian example. Social Science & Medicine (1982). 2006; 63:64-75. 3. Størksen HT, Garthus-Niegel S, Adams SS, Vangen S, Eberhard-Gran M. Fear of childbirth and elective cesarean section: a population-based study. BMC pregnancy and childbirth. 2015; 15: 221-242. 4. Salomonsson B, Wijma K, Alehagen S. Swedish midwives’ perceptions of fear of childbirth. Midwifery. 2010; 26(3):327-37. 5. Eriksson C, Westman G, Hamberg K. Content of Childbirth-Related Fear in Swedish Women and Men—Analysis of an Open-Ended Question. Journal of Midwifery & Women's Health. 2006; 51(2):112-8. 6. Klabbers GA, van Bakel HJ, van den Heuvel M, Vingerhoets AJ. Severe fear of childbirth: its features, assessment, prevalence, determinants, consequences and possible treatments. Psychological Topics. 2016; 25(1):107-27. 7. Nilsson C, Lundgren I. Women's lived experience of fear of childbirth. Midwifery. 2009; 25(2):e1-e9. 8. Monavare A, Esmat N. The effect of the imagination of the pain of vaginal delivery and the cesarean section on the selection of normal vaginal delivery in pregnant women attending clinics in Kerman University of Medical Sciences. Iranian Journal of Obstetrics, Gynecology, and Infertility. 2012; 14(7):6. 9. Fenwick J, Toohill J, Creedy DK, Smith J, Gamble J. Sources, responses and moderators of childbirth fear in Australian women: A qualitative investigation. Midwifery. 2015; 31(1):239-46. 10. Ghazaie M, Davoodi I, Neysi A, Honarmand M, Bassak Nejad S. The effectiveness of cognitive-behavioral therapy on the fear of childbirth, fear of pain, self-efficacy of childbirth and tendency to cesarean in nulliparous women. Iranian Journal of Obstetrics, Gynecology, and Infertility. 2016; 19(31):1-12. 11. Rouhe H, Salmela-Aro K, Halmesmäki E, Saisto T. Fear of childbirth according to parity, gestational age, and obstetric history. BJOG: an international journal of obstetrics and gynecology. 2009; 116: 67-73. 12. Serçekuş P, Okumuş H. Fears associated with childbirth among nulliparous women in Turkey. Midwifery. 2009; 25(2):155-62. 13. Stoll K, Edmonds JK, Hall WA. Fear of childbirth and preference for cesarean delivery among young American women before childbirth: a survey study. Birth. 2015; 42(3):270-6. 14. Ryding EL, Lukasse M, Parys ASV, Wangel AM, Karro H, Kristjansdottir H, et al. Fear of childbirth and risk of cesarean delivery: a cohort study in six European countries. Birth. 2015; 42(1):48-55. 15. Melender HL. Fears and coping strategies associated with pregnancy and childbirth in Finland. The Journal of Midwifery & Women’s Health. 2002; 47(4):256-63. 16. Naeimi N, Zare K, Salehi A. Attitude towards Fear of Vaginal Delivery and its Relationship with Awareness Level of the Pregnant Women Admitted to Social Security Hospital of Zahedan in the Year 2014. Community Health Journal. 2017; 9(1):10-8. 17. Adams S, Eberhard‐Gran M, Eskild A. Fear of childbirth and duration of labor: a study of 2206 women with intended vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology. 2012; 119(10):1238-46. 18. Dick-Read G. Childbirth without fear: the principles and practice of natural childbirth: Pinter & Martin Ltd; 2013. 19. El-Aziz SA, Mansour S, Hassan N. Factors associated with fear of childbirth: It’s effect on women’s preference for elective cesarean section. Journal of Nursing Education and Practice. 2017; 7: 133-45. 20. Andaroon N, Kordi M, Kimiaei SA, Esmaeily H. The effect of an individual counseling program by a midwife on fear of childbirth in primiparous women. Journal of education and health promotion. 2017; 6. 21. Abedian Z, Nikpour M, Mokhber N, Ebrahimi S, Khani S. Evaluation of the relationship between delivery mode and postpartum quality of life. The Iranian Journal of Obstetrics, Gynecology, and Infertility. 2010; 13(3):47-53. 22. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics, 24e: Mcgraw-hill; 2014. 23. Sobhy S, Arroyo-Manzano D, Murugesu N, Karthikeyan G, Kumar V, Kaur I, et al. Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet. 2019; 393(10184):1973-82. 24. Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstetrics & Gynecology. 2004; 103(5):907-12. 25. Shorten A, Chamberlain M, Shorten B, Kariminia A. Making choices for childbirth: development and testing of a decision-aid for women who have experienced the previous cesarean. Patient education and counseling. 2004; 52(3):307-13. 26. Saisto T, Halmesmäki E. Fear of childbirth: a neglected dilemma. Acta obstetricia et gynecologica Scandinavica. 2003; 82(3):201-8. 27. Marshall JE, Raynor MD. Myles' Textbook for Midwives E-Book: Elsevier Health Sciences; 2014. 28. Slade P, Balling K, Sheen K, Houghton G. Establishing a valid construct of fear of childbirth: findings from in-depth interviews with women and midwives. BMC Pregnancy and Childbirth. 2019; 19(1):96. 29. 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. Journal of Fasa University of Medical Sciences. 2014; 4(2):161-7. 30. Deklava L, Lubina K, Circenis K, Sudraba V, Millere I. Causes of anxiety during pregnancy. Procedia-Social and Behavioral Sciences. 2015; 205: 623-6. 31. Arfaie K, Nahidi F, Simbar M, Bakhtiari M. The role of fear of childbirth in pregnancy-related anxiety in Iranian women: qualitative research. Electronic physician. 2017; 9(2):3733. 32. Hanna‐Leena Melender R. Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women. Birth. 2002; 29(2):101-11. 33. 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. Journal of Hayat. 2016; 21(4):30-40. 34. LoBiondo-Wood G, Haber J. Nursing research-E-book: methods and critical appraisal for evidence-based practice: Elsevier HealthSciences; 2017. 35. Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: Advancing the humanistic imperative: Lippincott Williams & Wilkins; 2011. 36. Clissett P. Evaluating qualitative research. Journal of Orthopaedic Nursing. 2008; 12(2):99-105. 37. Dahlgren L, Emmelin M, Winkvist A. Qualitative methodology for international public health: Umeå Universitet; 2007. 38. Albers LL. The evidence for physiologic management of the active phase of the first stage of labor. Journal of midwifery & women's health. 2007; 52(3):207-15. 39. Nystedt A, Högberg U, Lundman B. Some Swedish women's experiences of prolonged labor. Midwifery. 2006; 22(1):56-65. 40. Soltani F, Eskandari Z, Khodakarami B, Parsa P, Roshanaei G. Factors contributing to fear of childbirth among pregnant women in Hamadan (Iran) in 2016. Electronic physician. 2017; 9(7):4725. 41. Toohill J, Fenwick J, Gamble J, Creedy DK. Prevalence of childbirth fear in an Australian sample of pregnant women. BMC pregnancy and childbirth. 2014; 14(1):275. 42. Lowe NK. The nature of labor pain. American journal of obstetrics and gynecology. 2002; 186(5): S16-S24. 43. Pascali‐Bonaro D, Kroeger M. Continuous female companionship during childbirth: a crucial resource in times of stress or calm. The Journal of Midwifery & Women’s Health. 2004; 49(S1):19-27. 44. Ahmad Shirvani M, Tayebi T, Bagheri-Nesami M. Exploration of women birth experiences role in deciding the type of next delivery. The Journal of Urmia Nursing and Midwifery Faculty. 2014; 12(4):286-96. 45. Ahmadi Z. Positive experiences of childbirth: a phenomenological study. Researcher. 2013; 5(12):30-41. 46. The Noble Quran. Raad Sura, verse 28 47. The Noble Quran. Talagh Sura, verse 3. 48. Hood Jr RW, Hill PC, Spilka B. The psychology of religion: An empirical approach: Guilford Publications; 2018. 49. Nilsson L, Thorsell T, Hertfelt Wahn E, Ekström A. Factors influencing positive birth experiences of first-time mothers. Nursing research and practice. 2013; 2013. 50. Gibbins J, Thomson AM. Women's expectations and experiences of childbirth. Midwifery. 2001; 17(4):302-13. 51. Ahmadi Z. Evaluation of the effect of continuous midwifery support on pain intensity in labor and delivery. Journal of Rafsanjan University of Medical Sciences. 2010; 9(4):293-304. 52. Larsson B, Hildingsson I, Ternström E, Rubertsson C, Karlström A. Women’s experience of midwife-led counseling and its influence on childbirth fear: A qualitative study. Women and Birth. 2019; 32(1):e88-e94. 53. Ford E, Ayers S, Wright DB. Measurement of maternal perceptions of support and control in birth (SCIB). Journal of women's health. 2009; 18(2):245-52. 54. Larkin P, Begley CM, Devane D. Women's experiences of labor and birth: an evolutionary concept analysis. Midwifery. 2009; 25(2):e49-e59. 55. Perry S, Cashion MC, Lowdermilk D. Clinical Companion for Maternity and Women's Health Care: Elsevier Health Sciences; 2007. 56. Rosen P. Supporting women in labor: analysis of different types of caregivers. Journal of Midwifery & Women's Health. 2004; 49(1):24-31. 57. Seefat-van Teeffelen A, Nieuwenhuijze M, Korstjens I. Women want proactive psychosocial support from midwives during the transition to motherhood: a qualitative study. Midwifery. 2011; 27(1):e122-e7. 58. Sydsjö G, Blomberg M, Palmquist S, Angerbjörn L, Bladh M, Josefsson A. Effects of continuous midwifery labor support for women with severe fear of childbirth. BMC pregnancy and childbirth. 2015; 15(1):115. 59. Ahmadi Z, Azimi H. Satisfaction of mothers with midwifery care in. Advances in Nursing & Midwifery. 2009; 19(67):30-5. 60. Aksoy M, Aksoy AN, Dostbil A, Celik MG, Ince I. The relationship between fear of childbirth and women’s knowledge about painless childbirth. Obstetrics and gynecology international. 2014; 7: 29. 61. Lally JE, Murtagh MJ, Macphail S, Thomson R. More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labor. BMC Medicine. 2008; 6(1):7.