Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study

Yoosefi Lebni, Javad; Khalajabadi Farahani, Farideh; Solhi, Mahnaz; Ebadifar Azar, Farbod

doi:10.18502/jri.v22i1.4995

Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study

Authors

Javad Yoosefi Lebni ¹

Farideh Khalajabadi Farahani ²

Mahnaz Solhi ¹

Farbod Ebadifar Azar ³

¹ Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran

² Department of Population and Health, National Population Studies and Comprehensive Management Institute, Tehran, Iran

³ Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran; Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran

10.18502/jri.v22i1.4995

Abstract

Background: Fear of childbirth is one of the most common problems among pregnant women that can threaten their and their baby’s health. Therefore, the purpose of this study was to explore the causes and grounds of childbirth fear and the strategies used by pregnant adolescent women in Iran to overcome such fears. Methods: In this study, which was conducted among primiparous Kurdish women in Iran, conventional qualitative content analysis was used. Data were selected through purposive sampling and semi-structured interviews. Data saturation was reached with 15 participants. The Lincoln and Guba criteria were used to strengthen the research. Results: After analyzing the data, two main categories were resulted. The first category was fear of childbirth with subcategories of fear of child health, fear of childbirth process, fears about inappropriate medical staff performance, fears about hospital environment, and postpartum fears. The second category was strategies to reduce childbirth fear with subcategories of choosing appropriate medical centers, increasing information on childbirth, avoiding stressful sources, improving self-care, getting prepared for delivery day in advance, and resorting to spirituality. Conclusion: Pregnancy in adult age is better than adolescent age. The women’s fear can be reduced by increasing their assurance about child health, providing appropriate training during pregnancy, explaining the whole process of childbirth and making it easier, improving the hospital environment and medical staff specialization, as well as providing appropriate conditions for further care and support after birth.

Keywords

Adolescent pregnancy

Childbirth

Fear

Qualitative study

Nour NM. Child marriage: a silent health and human rights issue. Rev Obstet Gynecol. 2009;2(1):51-6.

United Nations Fund for Population Activities (UNFPA). Marrying too young: end child marriage. 2012. New York: United Nations Population Fund; 2012. 76 p.

Supriyanto E, Eleanora FN. Early wedding polemic and the impact of the domestic violence. Law Justice. 2020;5(1):30-8.

Lebni JY, Solhi M, Fard Azar FE, Farahani FK. Qualitative study of social determinants of child marriage in Kurdish regions of Iran: Evidence for health promotion interventions. J Edu Health Promot. 2020;9:242.

Parsons J, Edmeades J, Kes A, Petroni S, Sexton M, Wodon Q. Economic impacts of child marriage: a review of the literature. Rev Faith Int Aff. 2015;13(3):12-22.

Akhlaghi F, Mokhber N, Shakeri MT, Shamsa F. Relation between depression, anxiety, self-esteem, marital satisfaction, demographical factor and maternal complications with fear of childbirth in nulliparous women. J Fundamentals Mental Health. 2012;14(2):122-31.

Ahinkorah BO, Hagan Jr JE, Seidu AA, Mintah JK, Sambah F, Schack T, et al. Examining pregnancy related socio-cultural factors among adolescent girls in the komenda-edina-eguafo-abrem municipality in the central region of Ghana: a case-control study. Front Public Health. 2019;7:93.

Osborne C, Ankrum N. Mom, I’m pregnant: the adolescent pregnancy reveal. Soci Service Rev. 2020;94(2):339-72.

Farahani FK. Adolescents and young people’s sexual and reproductive health in Iran: a conceptual review. J Sex Res. 2020;57(6):743-80.

Yasmin G, Kumar A, Parihar B. Teenage pregnancy-its impact on maternal and fetal outcome. Int J Sci Stud. 2014;1(6):9-13.

Storksen HT, Eberhard‐Gran M, Garthus‐Niegel S, Eskild A. Fear of childbirth; the relation to anxiety and depression. Acta Obstet Gynecol Scand. 2012;91(2):237-42.

Toohill J, Fenwick J, Gamble J, Creedy DK, Buist A, Ryding EL. Psycho-social predictors of childbirth fear in pregnant women: an Australian study. Open J Obstet Gynecol. 2014;4(9):531.

Spice K, Jones SL, Hadjistavropoulos HD, Kowalyk K, Stewart SH. Prenatal fear of childbirth and anxiety sensitivity. J Psychosom Obstet Gynecol. 2009;30(3):168-74.

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.

Munkhondya BM, Munkhondya TE, Chirwa E, Wang H. Efficacy of companion-integrated childbirth preparation for childbirth fear, self-efficacy, and maternal support in primigravid women in Malawi. BMC Pregnancy Childbirth. 2020;20(1):48.

Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med. 2016;46(6):1121-34.

Beijers R, Buitelaar JK, de Weerth C. Mechanisms underlying the effects of prenatal psychosocial stress on child outcomes: beyond the HPA axis. Eur Child Adolesc Psychiatry. 2014;23(10):943-56.

Aksoy M, Aksoy AN, Dostbil A, Celik MG, Ince I. The relationship between fear of childbirth and women’s knowledge about painless childbirth. Obstet Gynecol Int. 2014;2014:274303.

Alder J, Breitinger G, Granado C, Fornaro I, Bitzer J, Hösli I, et al. Antenatal psychobiological predictors of psychological response to childbirth. J Am Psychiatr Nurses Assoc. 2011;17(6):417-25.

Handelzalts JE, Becker G, Ahren MP, Lurie S, Raz N, Tamir Z, et al. Personality, fear of childbirth and birth outcomes in nulliparous women. Arch Gynecol Obstet. 2015;291(5):1055-62.

Laursen M, Hedegaard M, Johansen C. Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort. BJOG. 2008;115(3):354-60.

Lukasse M, Vangen S, Øian P, Kumle M, Ryding EL, Schei B, et al. Childhood abuse and fear of childbirth--a population‐based Study. Birth. 2010;37(4):267-74.

Heimstad R, Dahloe R, Laache I, Skogvoll E, Schei B. Fear of childbirth and history of abuse: implications for pregnancy and delivery. Acta Obstet Gynecol Scand. 2006;85(4):435-40.

Abbaspoor Z, Moghaddam BL, Ahmadi F, Kazemnejad A. Women's fear of childbirth and its impact on selection of birth method: a qualitative study. Payesh. 2014;13(5):575-87

Karami K. A comparison of life quality and public health after natural and cesarean delivery in women referred to Khorramabad health centers in 2009-2011. Yafteh. 2012;14(4):59-69.

Dencker A, Nilsson C, Begley C, Jangsten E, Mollberg M, Patel H, et al. Causes and outcomes in studies of fear of childbirth: a systematic review. Women Birth. 2019;32(2):99-111.

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 Childbirth. 2019;19(1):96.

Johnson AR, Kumar MG, Jacob R, Jessie MA, Mary F, Agrawal T, et al. Fear of childbirth among pregnant women availing antenatal services in a maternity hospital in rural Karnataka. Indian J Psychol Med. 2019;41(4):318-22.

Nieminen K, Andersson G, Wijma B, Ryding EL, Wijma K. Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study. J Psychosom Obstet Gynecol. 2016;37(2):37-43.

Spoozak L, Gotman N, Smith MV, Belanger K, Yonkers KA. Evaluation of a social support measure that may indicate risk of depression during pregnancy. J Affect Disord. 2009;114(1-3):216-23.

Kızılırmak A, Başer M. The effect of education given to primigravida women on fear of childbirth. Appl Nurs Res. 2016;29:19-24.

Junge C, von Soest T, Weidner K, Seidler A, Eberhard‐Gran M, Garthus‐Niegel S. Labor pain in women with and without severe fear of childbirth: a population‐based, longitudinal study. Birth. 2018;45(4):469-77.

Laurenzi CA, Gordon S, Abrahams N, du Toit S, Bradshaw M, Brand A, et al. Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review. Reprod Health. 2020;17(1):65.

Laursen M, Johansen C, Hedegaard M. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort. BJOG. 2009;116(10):1350-5.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12.

Lincoln YS, Guba E. Naturalistic Inquiry London. 1st sd. England: Sage Publications; 1985. 415 p.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57.

Karlström A, Engström-Olofsson R, Nystedt A, Thomas J, Hildingsson I. Swedish caregivers’ attitudes towards caesarean section on maternal request. Women Birth. 2009;22(2):57-63.

Lowe NK. Self-efficacy for labor and childbirth fears in nulliparous pregnant women. J Psychosom Obstet Gynecol. 2000;21(4):219-24.

Alehagen S, Wijma K, Wijma B. Fear during labor. Acta Obstet Gynecol Scand. 2001;80(4):315-20.

Geissbuehler V, Eberhard J. Fear of childbirth during pregnancy: a study of more than 8000 pregnant women. J Psychosom Obstet Gynecol. 2002;23(4):229-35.

Okonkwo NS, Ojengbede OA, Morhason-Bello IO, Adedokun BO. Maternal demand for cesarean section: perception and willingness to request by Nigerian antenatal clients. Int J Womens Health. 2012;4:141-8.

Sjögren B. Reasons for anxiety about childbirth in 100 pregnant women. J Psychosom Obstet Gynecol. 1997;18(4):266-72.

Haines H, Pallant JF, Karlström A, Hildingsson I. Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample. Midwifery. 2011;27(4):560-7.

Poikkeus P, Saisto T, Unkila-Kallio L, Punamaki RL, Repokari L, Vilska S, et al. Fear of childbirth and pregnancy-related anxiety in women conceiving with assisted reproduction. Obstet Gynecol. 2006;108(1):70-6.

Klabbers GA, van Bakel HJ, van den Heuvel M, Vingerhoets AJ. Severe fear of childbirth: its features, assesment, prevalence, determinants, consequences and possible treatments. Psychol Topics. 2016;25(1):107-27.

Larsson B, Hildingsson I, Ternström E, Rubertsson C, Karlström A. Women’s experience of midwife-led counselling and its influence on childbirth fear: a qualitative study. Women Birth. 2019;32(1):e88-e94.

Bryanton J, Gagnon AJ, Johnston C, Hatem M. Predictors of women’s perceptions of the childbirth experience. J Obstet Gynecol Neonatal Nurs. 2008;37(1):24-34.

Hauck Y, Fenwick J, Downie J, Butt J. The influence of childbirth expectations on Western Australian women's perceptions of their birth experience. Midwifery. 2007;23(3):235-47.

Onchonga D, Várnagy Á, Keraka M, Wainaina P. Midwife-led integrated pre-birth training and its impact on the fear of childbirth. a qualitative interview study. Sex Reprod Healthc. 2020;25:100512.

Melender HL. Fears and coping strategies associated with pregnancy and childbirth in Finland. J Midwifery Womens Health. 2002;47(4):256-63.

Teekhasaenee T, Kaewkiattikun K. Birth preparedness and complication readiness practices among pregnant adolescents in Bangkok, Thailand. Adolesc Health Med Ther. 2020;11:1-8.

Romero ST, Coulson CC, Galvin SL. Cesarean delivery on maternal request: a western North Carolina perspective. Matern Child Health J. 2012;16(3):725-34.

Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials. Prev Med. 2013;56(6):351-64.

Clapp III JF. The effects of maternal exercise on fetal oxygenation and feto-placental growth. Eur J Obstet Gynecol Reprod Biol. 2003;110 Suppl 1:S80-5.

Davenport MH, Marchand AA, Mottola MF, Poitras VJ, Gray CE, Garcia AJ, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2019;53(2):90-8.

Dziegielewski S, Jacinto GA. Childbirth educators self-care. Int J Childbirth Educ. 2018;33(3):27-30.

Wulcan AC, Nilsson C. Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study. Sex Reprod Healthca. 2019;19:24-30.