Fear of childbirth and its contributing factor – An exploratory study at a tertiary care hospital

Kanchan Sharma; Himanshu Vyas; Meenakshi Gothwal; Gomathi Arumugam

doi:10.4103/iopn.iopn_64_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 19 | Issue : 2 | Page : 98-103

Fear of childbirth and its contributing factor – An exploratory study at a tertiary care hospital

Kanchan Sharma¹, Himanshu Vyas², Meenakshi Gothwal³, Gomathi Arumugam⁴
¹ Student, College of Nursing, AIIMS, Jodhpur, Rajasthan, India
² Lecturer, College of Nursing, AIIMS, Jodhpur, Rajasthan, India
³ Assistant Professor, Department of Obstetrics and Gynecology, AIIMS, Jodhpur, Rajasthan, India
⁴ Associate Professor, College of Nursing, AIIMS, Jodhpur, Rajasthan, India

Date of Submission	09-Jul-2021
Date of Decision	09-Sep-2021
Date of Acceptance	06-Dec-2021
Date of Web Publication	27-Dec-2022

Correspondence Address:
Mr. Himanshu Vyas
Associate Professor, College of Nursing, AIIMS, Jodhpur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iopn.iopn_64_21

Abstract

Background: Motherhood and pregnancy are cherished moments in a life and considered one of the most important events in a women's life. So, she does the best to maintain good health to bring into this world a healthy baby. The fear of pregnancy is called tocophobia and it is defined as an intense state of anxiety which leads to fear of childbirth. Fear of childbirth result in increased number of visits to the obstetrician and in frequent request for cesarean delivery. The study aimed to assess the fear of childbirth and factors contributing to fear of childbirth among primigravidae at a tertiary care teaching hospital. Methodology: Descriptive design with Quantitative approach was used and a sample of 269 primigravidae women by using consecutive sampling. Data was collected at Antenatal OPD, by using standardized tool Wijma delivery expectancy questionnaire Version – A and a checklist for factors contributing to fear of childbirth. Results: Level of fear of childbirth among primigravidae (24.4%) having severe level, (44.8%) high level and 24.1% having moderate level, 6.7% low level of fear of childbirth. Major contributing factor for fear of childbirth was Fear of labor pain (80.7%), and least common was disturbed self image and feeling of insecurity (27.9%). Conclusion: Majority of the primigravidae women face fear of childbirth, as contributed by various factors that affect fear of childbirth. Primigravidae women were counseled on one to one basis and they were made aware about the physiology of labor and what to expect during labor to alleviate their fear after the completion of the data collection process.

Keywords: Contributing factors, fear of childbirth, primigravidae, Wijma DEQ version – A

How to cite this article:
Sharma K, Vyas H, Gothwal M, Arumugam G. Fear of childbirth and its contributing factor – An exploratory study at a tertiary care hospital. Indian J Psy Nsg 2022;19:98-103

How to cite this URL:
Sharma K, Vyas H, Gothwal M, Arumugam G. Fear of childbirth and its contributing factor – An exploratory study at a tertiary care hospital. Indian J Psy Nsg [serial online] 2022 [cited 2023 Jun 1];19:98-103. Available from: https://www.ijpn.in/text.asp?2022/19/2/98/365469

Introduction

In all societies, family is the central nucleus of people and women form the backbone of it. For the family and for women pregnancy and birth of baby are the most special and exciting events. Pregnancy and childbirth are special event in a women's life and indeed in the lives of family. Pregnancy is a normal physiological events, but it is also correlated with risk to Survival and health of the mother and baby and also at times can lead to morbidity and mortality of the mother and child. 80% maternal death in India results from hemorrhage, anemia, sepsis, toxemia etc., Among the four components of labor the pelvis, passage, power and psyche, the psychological condition of the mother plays a very important role in conduction of normal delivery. Anxiety, fear and poor knowledge of the mother in seeking proper maternal care services at the right time may contribute to maternal mortality and morbidity. If anxiety, fear of childbirth can be addressed at the right time the maternal complications can be decreased to a great extent.^[1] Physiological, psychological, hormonal and social changes are occurring during the pregnancy which increases risk of emotional suffering in the women. Outcomes of the pregnancy are affected by the level of stress women experiences and women's ability to adopt to the changes and challenges of pregnancy. According to Areskog et al., Melender, Andersson et al., and Söderquist et al., one in five pregnant women experiences moderate fear of childbirth, and 6%–13% of pregnant women experience severe, disabling fear of childbirth.^{[2],[3],[4],[5]}

Childbirth is a new experience to the women in which primigravidae experience a lot of physical and emotional changes, which may trigger their anxiety and fear related to childbirth process because they do not know about what changes takes place and what is their role. In some women childbirth process is a joyous relationship of hopes, but together with this they have mass of fears and anxieties related to health of baby about their own reaction to labor and also about the person's attitude who will care and help them in their pregnancy period. Childbirth is a process associated with both pleasure and pain. The prevalence of childbirth related fear is around 20% and from this approximately 6%–10% of woman experiencing intense fear of labor and birth that is dysfunctioning or disabling.^[6] Around 13% of nonpregnant women who have not given birth in their life are fearful and avoid or postpone pregnancy.^[7] Pregnant women who have increased level of fear of childbirth frequently requests for cesarean section and also go to the hospital for somatic symptoms due to fear. In more fearful pregnant women planned cesarean section without medical reason are high.^[8] Handelzalts et al. revealed that only psychological variables are responsible for preference of mother for cesarean section, and the fear may be related to her child or herself, gender of the baby, loss of baby, fear of preterm child mentally handicapped child or congenital abnormalities, fear of surgery, fear of family members undesirable attitude of the new environment which may cause for the problem during labor.^[9]

Girija et al. revealed that anxiety is associated with the unplanned cesarean request by mothers and also found severe anxiety of childbirth that is 93% among third trimester pregnant. From Sweden England, Iran, Hong Kong, Portugal, Danish and Spain reported (14%–54%) prevalence of fear and anxiety during childbirth.^{[10],[11],[12],[13],[14],[15]} Study result shows high pregnancy related anxiety mainly anxiety of childbirth in low risk third trimester nulliparous pregnant women.^[12],[13] In a study conducted in Kerala revealed that anxiety of childbirth and poor knowledge on childbirth preparation (90%–94%) were high in nulliparous women.^[14] The Objectives of study were to assess the fear of child birth among primigravidae women at a tertiary care teaching hospital and to determine the factors contributing to fear of childbirth among them.

Methodology

The study was conducted to assess the level of fear and its contributing factors, the researcher used the nonexperimental Descriptive research design with Quantitative approach. The current study consisted of a sample of 269 primigravidae women selected by using nonprobability consecutive sampling. Primigravidae with more than 35 weeks of gestation were approached and information related to purpose of study was given. Confidentiality was assured and written consent was taken. Approximately 15–20 min time was taken to complete the data collection process. Using the standardized tool Wijma delivery expectancy questionnaire Version – A. This tool has 6 statements, first statements have 2 items, second statement have 18 items, third statements have 6 items, fourth statement have 3 items, fifth statement have 4 items and sixth statement have 2 items. Total items were 33. Highest possible score was 165 and lowest possible score was 0 and the score was interpreted as low fear (0–37), moderate fear (38–64) and high fear (65–84) and severe (85–165). This tool consists of positive and negative items and the scoring for each items range from 0 to 5. This tool was translated to Hindi Negatively framed items are reversed scored. Formal permission was obtained from the author to use the tool. And a checklist for factors contributing to fear of childbirth. Inclusion criteria for participants should be registered primigravidae. Primigravidae age group 19–31 years of age, and Period of gestation more than 35 weeks of pregnancy. Researcher developed a checklist to identify the factors contributing to fear of childbirth. Total numbers of items are 18 and the items of this list were interpreted in proportions as most common and least common contributing factors. Checklist was sent to various nursing experts for validation and was found to be valid with a S-CVI/Ave of 0.97.

Pilot study was done among 15 primigravidae women more than 35 weeks of gestation, at antenatal OPD. Ethical Clearance has been obtained from the Institutional Ethics Committee. Certificate Reference Number: IEC/2020-21/3027. Written Informed consent was obtained from each study subjects involved in the study. All the subjects were informed about their participation in the research, objectives of the study, duration of their involvement and probable use of findings of the study. Confidentiality of data was maintained and the study subjects were given full autonomy to withdraw from the study at anytime. Data was collected by the face-to-face interview. Data was entered into master sheet and SPSS 26 version was used for the descriptive and inferential statistical analysis.

Results

As per [Table 1], mean age of primigravidae was 25.7 years and more than half of the primigravidae (51.7%) belonged to the age group of 24–28 years. Mean duration of pregnancy in weeks was 37.3 ± 1.3 and more than half of primigravidae (62.8%) were having gestational age between 36 and 38 weeks. Among 269 primigravidae (66.2%) were graduation and above category of education and out of total (66.5%) Primigravidae were homemaker. Majority of primigravidae (87.4%) belonged to Hindu religion. Marriage duration of more than half of primigravidae (56.5%) was 1–3 years. In type of family (67.3%) primigravidae were belonged to joint family. Family income of nearly half of the primigravidae (47.6%) was above >30,000/-per month. More than half of primigravidae (58.4%) visited antenatal OPD 4–10 times during their pregnancy. Most of the primigravidae (68.8%) belonged to the urban area.

Table 1: Frequency and percentage distribution of primigravidae as per personal variables (n=269)

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[Table 2] reveals that among primigravidae more than 35 weeks of gestation. Almost one fourth of primigravidae (24.4%) were having severe level of fear and almost half (44.8%) were having high level of fear. 24.1%0f primigravidae were having moderate level of fear of childbirth followed by 6.7% primigravidae having low level of fear of childbirth.

Table 2: Level of fear of childbirth among primigravidae (n=269)

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[Table 3] is showing that fear of labor pain (80.7%), worries about episiotomy (79.6%), uncertainty of duration of labor (76.2%) and being a primigravidae (68.4%) were most common factors identified in primigravidae contributing to fear of childbirth among primigravidae. Lack of family support (16.4%), family genetic predisposition (25.3%), bad obstetrics history of family members (26%) and Disturb self image and feeling of insecurity (27.9%) were the least contributing factors for fear of childbirth among primigravidae. 8.1% of primigravidae also reported other factors that were not included in the checklist factors contributing to fear of childbirth. Other factors that contributed to fear of childbirth among primigravidae were fear of cesarean section, labor may start before due date, delay in reaching hospital, delivery of baby in between the way to hospital, labor pain may not start after completion of term, worries related to expenditure of the delivery if cesarean section done, complications during childbirth, what will happen if she got exhausted during delivery, more distance from hospital, How to differentiate between labor pain and other pain, fear that she may deliver a baby of an unwanted gender, fear that her baby may have some complications during childbirth etc., No personal variables was found to be significantly associated with fear of childbirth at P < 0.05 level of significance.

Table 3: Factors contributing to fear of childbirth (n=269)

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Discussion

The results of the present study showed that more than half of the primigravidae were in age group of 24–28 years and mean age was 25.7 ± 3.3 consistent with the study done by Sanjay jaju et al.(2015)^[16] in which mean age was 22.76 ± 2.9. Mean and standard deviation of gestation weeks of primigravidae was 37.3 ± 1.3 and more than half of primigravidae (62.8%) were having gestational weeks between 36 and 38 weeks consistent with the study done by Andaroon et al.^[17] in which primigravidae having 34–36 weeks of pregnancy. The findings of the present study indicated that the majority of the primigravidae (87.4%) were Hindu consistent with the study done by Johnson et al.^[18] in which out of total 86.9% primigravidae was from Hindu religion. Most of the primigravidae (66.2%) 52 were graduation and above category similar results have been seen in the study conducted by Johnson et al. where 48.7% of pregnant women were having college and above category of education. Marriage duration of more than half of primigravidae (56.5%) were 1–3 years, similar result found study conducted by Devilata et al.^[19] where marital life in year was 1–3 years in most of women (53.3%). In type of family most of the primigravidae (67.3%) belonged to joint family consistent with the study done by Ningthoujam et al.^[20] in which out of total 78.6% primigravidae belonged to join family. More than half of primigravidae (58.4%) visited antenatal OPD 4–10 times during their pregnancy Consistent results have been seen in the study conducted by Devilata et al. that 63.3% primigravidae attended more than 3 time antennal OPD during pregnancy. In present study most of the primigravidae (68.8%) were belonged to the urban area consistent with study conducted by Devilata et al. where out of total most of the primigravidae 86.8% were belong to urban area. In current study Mean score of fear of childbirth was 72.6 ± 21.3. 24.4% of primigravidae were having severe level of fear, 44.8% of primigravidae were having high fear of childbirth 24.1% primigravidae were having moderate fear of childbirth and 6.7% primigravidae were having Low level of fear of childbirth [Figure 1]. The results were somewhat consistent with finding reported by Khwepeya et al.^[21] 39% reported low levels of fear, 41% were moderately fearful and 20% were highly fearful. Skodova et al.^[22] mean level of fear was 68.8 ± 11.6. According to study conducted by Nasr et al.^[23] 7.75% of total sample did not have any fear, 13.33% of them had low level of fear, 23.6% had moderate level of fear and 55.3% had 53 high level of fear. According to Tiruset Gelaw et al.^[24] 40 (10.3%) of the pregnant women had a low fear, 154 (39.8%) had a moderate fear, 98 (25.3%) had a high fear, and 95 (24.5%) had severe level fear of childbirth. During pregnancy about 20% of women had a relatively high level of fear a distribution of similar to previous studies that used the same assessment tool in Canadian 25% (Hall et al.) Australian 24%–27% (Fenwick et al. and Toohi et al.) and Swedish 26% (Zar et al.). In present study fear of labor pain (80.7%), worries about episiotomy (79.6%), uncertainty of duration of labor (76.2%) and being a primigravidae (68.4%) was most common factors present in primigravidae that contribute to fear of childbirth among primigravidae [Figure 2]. Beiranvand et al.^[25] lack of sufficient income for living expense, not participating in childbirth preparation classes and preferences for mode of delivery were predictive factors for the fear of childbirth. O'Connell et al.^[26] those with low informational support were more likely to report high FOC.

Figure 1: Fear of childbirth among primigravidae at AIIMS, Jodhpur

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Figure 2: Factors contributing to fear of childbirth in primigravidae

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Individual and group counseling sessions can be organized for primigravidae women as part of antenatal preparation of primigravidae women for delivery. Counseling regarding normal physiological and psychological changes during pregnancy and the physiology of labor and what to expect during labor can help the primigravidae women to alleviate the fear of childbirth.

Conclusion

The result of the study indicate that primigravidae women were having low to severe fear of childbirth and 68%–70% were having high to severe fear of childbirth. Multiple factors contribute to increase their fear level. There is a need of education of antenatal mothers regarding fear of childbirth during their antenatal visits. Health care providers should create awareness and improve the knowledge of mothers regarding fear of childbirth and its contributing factors. A regular screening related to their fear of childbirth among all pregnant mothers should be promoted and health awareness program should be conducted for better utilization of health services.

Acknowledgement

We are thankful to Institutional Ethics Committee (IEC) for approval for conducting the research study. We would like to thank Dept. of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur and primigravidae who participated in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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