Effectiveness of cognitive-behavioural therapy and psycho-education on fear of natural childbirth and its related variables

Document Type : Original Article

Authors

1 mashhad medical university

2 , assistant professor in clinical psycholog

3 Professor, Department of Psychology, Shahid Chamran University, Ahwaz, Iran

4 Associate professor, Department of Psychology, Shahid Chamran University, Ahwaz, Iran

Abstract

Aim: The aim of the current study was the determination of the effectiveness of cognitive behavioural therapy in comparison with psycho-education, on the fear of childbirth and its related variables. Methods: Method was quasi-experimental and the statistical population of nulliparous women from Ahvaz was 8000. Among them 54 women who had the entrance criteria for being considered in the research were selected. Selection was based on participants’ availability and they were randomly assigned to three groups of 18 women. Research tools were Wijma, Wijma and Zar’s Delivery Expectancy Questionnaire (1998) McCracken and Dhingra’s Pain Anxiety Symptoms (2002), Lowe’s Childbirth Self-Efficacy Inventory (1993), also nine sessions of 90-minute of cognitive-behavioral therapy Niminen (2016) and six sessions of  90-minute of psycho-education (Rouhi, Salmela‐Aro, Toivanen, Tokola, Halmesmäki & Saisto, 2013) for two times a week. After removing eight persons due to their absentees in two-thirds of sessions, the data of 46 persons were analyzed by the use of covariance method and comparison of two independent ratios. Results: Result revealed that cognitive behavioural therapy decreases the fear of childbirth (F= 70.64, P= 0.001), fear of pain (F= 4.25, P= 0.02) and increases the tendency to natural childbirth (Z= 3.12, P= 0.002) and self-efficacy of childbirth (F=108.73, P= 0.001) and its effectiveness on these variables is more than psychoeducation. Psychoeducation only led to the increase of self-efficacy of childbirth (F=108.73, P= 0.001) and a decrease of fear of childbirth (F= 70.64, P= 0.01). The difference in the final frequency of natural childbirth in the cognitive behavioural group with the control group (Z= 1.56, P= 0.1) and psychoeducation (Z= 0.7, P= 0.4) group was not significant. Conclusion: Snce cognitive behavioural therapy uses behavioural strategies and targets the irrational thoughts of women toward natural childbirth, it leads to the decrease of fear of childbirth. And more effective than psychological training in the aforementioned fields.

Keywords


  1. اتقایی، منوره.، و نوحی، عصمت. (1390). تصور از درد زایمان طبیعی و سزارین و تمایل به زایمان طبیعی در زن‌های باردار مراجعه‌‌کننده به درمانگاه‌های دانشگاه علوم پزشکی شهر کرمان. مجله زنان، مامایی و نازایی ایران، 14(7): 50-44.
  2. احمدی کانی‌گلزار، ارسلان.، اصغرنژاد، سحر.، و قلی‌زاده، زلیخا. (1392). اثربخشی درمانگری شناختی-رفتاری بر سه عامل پویشی تعارض‌های وابستگی، خشم و مادری در مادران افسرده پس از زایمان. فصلنامه روان‌شناسی کاربردی، 7(2 پیاپی 26): 60-41.
  3. بختیاری، آزاده.، و عابدی، احمد. (1391). اثربخشی درمان گروهی مبتنی بر الگوی فراشناختی ذهن‌آگاهی انفصالی بر افسردگی پس از زایمان، فصلنامه روان‌شناسی کاربردی، 6(2 پیاپی 22): 24-9.
  4. پاک‌نژاد، محسن.، اصغری‌مقدم، محمدعلی.، رحیمی‌نژاد، عباس.، رستمی، رضا.، و طاهری، آرمان. (1393). ساختار عاملی و ویژگی‌های روان‌سنجی نسخه فارسی مقیاس نشانگان اضطراب درد. فصلنامه پژوهش‌های کاربردی روان‌شناختی، 5(3): 94-71.
  5. خورسندی، محبوبه.، غفرانی‌پور، فضل‌الله.، حیدرنیا، علی‌رضا.، فقیه‌زاده، سقراط.، وفایی، مریم.، روستا، فیروزه.، و امین شکروی، فرخنده. (1387). اثر کلاس آموزشی زایمان بر خودکارامدی زنان نخست‌زا در مقابله با درد زایمان. مجله علمی پژوهشی دانشگاه علوم پزشکی اراک، 11(3): 65-56.
  6. سعیدی، رضا.، معموری، غلامعلی.، آیتی، صدیقه.، رحمانی، شقایق.، و غلامی رباط سنگی، محبوبه. (1388). مقایسه عوارض نوزادی در نوزادان حاصل از سزارین و زایمان طبیعی. مجله دانشگاه علوم پزشکی و خدمات بهداشتی درمانی سبزوار، 16(2): 113-108.
  7. عمیدی مظاهری، مریم.، امیری، مسعود.، خورسندی، محبوبه.، حسن‌زاده، اکبر.، و طاهری، زهرا. (1394). آیا با آموزش می‌توان سزارین را کاهش داد؟ پایش، 14(3): 585-577.
  8. موسوی‌نیا، رؤیا.، گلزاری، محمود.، و برجعلی، احمد. (1393). اثربخشی آموزش تحمل بلاتکلیفی به‌شیوه شناختی-رفتاری بر اختلال اضطراب فراگیر. روان‌شناسی کاربردی، 8(3 پیاپی 31): 59-41.
  9. Barry, S., Schifrin, M., Wayne, R., & Cohen, M. (2013). The effect malpractice claims on the use of caesarean section. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(2): 269-283.
  10. Escott, D., Slade, P., & Spiby, H. (2009). Preparation for pain management during childbirth: The psychological aspects of coping strategy development in antenatal education. Clinical Psychology Review, 29(7): 617-622.
  11. Faisal, I., Matinnia, N., Hejar, A., & Khodakarami, Z. (2014). Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery, 30(2): 227-233.
  12. Fenwick, J., Gamble, J., Creedy, D. K., Buist, A., Turkstra, E., Sneddon, A., Scuffham, P. A., Ryding, E. L., Jattett, V. & Toohill, J. (2013). Study protocol for reducing childbirth fear: A midwife-led psycho-education intervention. BMC Pregnancy and Childbirth, 13(1): 1-15.
  13. Guszkowska, M. (2014). The effect of exercise and childbirth classes on fear of childbirth and locus of labor pain control. Anxiety, Stress & Coping, 27(2): 176-189.
  14. Howharn, C. (2008). Effects of childbirth preparation classes on self-efficacy in coping with labor pain in Thai primiparas. Doctoral thesis. The University of Texas at Austin.
  15. Karabulut, O., CoşkunerPotur, D., DoğanMerih, Y., CebeciMutlu, S., & Demirci, N. (2016). Does antenatal education reduce fear of childbirth? International Nursing Review, 63(1): 60-67.
  16. Kohl, A., Rief, W., & Glombiewski, J. A. (2013). Acceptance, cognitive restructuring, and distraction as coping strategies for acute pain. The journal of Pain, 14(3): 305-315.
  17. Larsson, B., Karlström, A., Rubertsson, C., & Hildingsson, I. (2016). Counseling for childbirth fear–a national survey. Sexual & Reproductive Healthcare, 8(1): 82-87.
  18. Lowe, N. K. (1993). Maternal confidence for labor: Development of the childbirth self‐efficacy inventory. Research in Nursing & Health, 16(2): 141-149.
  19. McCracken, L. M., & Dhingra, L. (2002). A short version of the pain anxiety symptoms scale (PASS-20): preliminary development and validity. Pain Research and Management, 7(1): 45-50.
  20. Nieminen, K. (2016). Clinical aspects of childbirth-related anxiety. Sweden: liu-Tryck.
  21. Rouhe, H., Salmela‐Aro, K., Toivanen, R., Tokola, M., Halmesmäki, E., & Saisto, T. (2013). Obstetric outcome after intervention for severe fear of childbirth in nulliparous women–randomised trial. BJOG: An International Journal of Obstetrics &Gynaecology, 120(1): 75-84.
  22. Salmela-Aro, K., Read, S., Rouhe, H., Halmesmäki, E., Toivanen, R. M., & Tokola, M. I. (2012). Promoting positive motherhood among nulliparous pregnant women with an intense fear of childbirth: RCT intervention. Journal of Health Psychology, 17(4): 520-534.
  23. Salomonsson, B. (2012). Fear is in the air: Midwives´ perspectives of fear of childbirth and childbirth self-efficacy and fear of childbirth in nulliparous pregnant women. Printed in Sweden by Liu-Tryck, Linköping: Sweden.
  24. Serçekuş, P., & Başkale, H. (2016). Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment. Midwifery, 34(2): 166-172.
  25. Sun, Y. C., Haung, Y. C., Chang, Y., & Kou, S. C. (2010). Effects of a parental yoga programme on the discomforts of pregnancy and mental childbirth self-efficacy in Taiwan. Midwifery, 26(6): 31-36.
  26. Sydsjö, G., Sydsjö, A., Gunnervik, C., Bladh, M., &Josefsson, A. (2012). Obstetric outcome for women who received individualized treatment for fear of childbirth during pregnancy. Acta obstetrician ET Gynecologica Scandinavica, 91(1): 44-49.
  27. Stoll, K., & Hall, W. (2013). Vicarious birth experiences and childbirth fear: does it matter how young Canadian women learn about birth? The Journal of Perinatal Education, 22(4): 226-233.
  28. Tofighi Nia, M., Behmanesh, F., Mashmuli, F., & Azimi, H. (2010). The effect of prenatal group education on knowledge, attitude and selection of delivery type in primiparous women. Iranian Journal of Medical Education, 10(2): 124-130
  29. Turk, D. C., & Wilson, H. D. (2010). Fear of pain as a prognostic factor in chronic pain: conceptual models, assessment, and treatment implications. Current Pain and Headache Reporst, 14(2): 88-95.
  30. Weaver, J., Browne, J., Aras-Payne, A., & Magill-Cuerden, J. (2012). A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth). JBI Database of Systematic Reviews and Implementation Reports, 10(28): 1-20.
  31. Wijma, K., Wijma, B., &Zar, M. (1998). Psychometric aspects of the W-DEQ; A new questionnaire for the measurement of fear of childbirth. Journal of Psychosomatic Obstetrics & Gynecology, 19(2): 84-97.