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Fear is in the air: Midwives´ perspectives of fear of childbirth and childbirth self-efficacy and fear of childbirth in nulliparous pregnant women
Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: In Western countries, about one pregnant woman in five experiences a considerable fear of childbirth (FOC). Consequently FOC is an important topic for midwives, being pregnant women’s main care givers. Also, although many aspects of FOC have been studied, almost no studies have into detail applied a theoretical frame of reference for studying pregnant women’s expectations for their upcoming labour and delivery. Therefore, the theory of self-efficacy, here regarding pregnant women’s belief in own capability to cope with labour and delivery, has been applied with the aim to better understand the phenomenon of FOC.

Aim: The overall aims of the thesis were to describe midwives´ perceptions and views on FOC and to expand the current knowledge about expectations for the forthcoming birth in nulliparous women in the context of FOC.

Method: Study I had a descriptive design. In total 21 midwives, distributed over four focus-groups, participated. Data were analysed by the phenomenographic approach. Studies II and III had cross sectional designs. Study II comprised 726 midwives, randomly selected from a national sample that completed a questionnaire that addressed the findings from Study I. Study III included 423 pregnant nulliparous women. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), self-efficacy by the Childbirth Self-Efficacy Inventory (CBSEI). Study IV had a descriptive interpretative design. Seventeen women with severe FOC were conveniently selected from the sample of Study III and individually interviewed. Content analyses, both deductive and inductive, were performed.

Method: Study I had a descriptive design. In total 21 midwives, distributed over four focus-groups, participated. Data were analysed by the phenomenographic approach. Studies II and III had cross sectional designs. Study II comprised 726 midwives, randomly selected from a national sample that completed a questionnaire that addressed the findings from Study I. Study III included 423 pregnant nulliparous women. FOC was measured using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), self-efficacy by the Childbirth Self-Efficacy Inventory (CBSEI). Study IV had a descriptive interpretative design. Seventeen women with severe FOC were conveniently selected from the sample of Study III and individually interviewed. Content analyses, both deductive and inductive, were performed.

Conclusions: Swedish midwives regard severe FOC as a serious problem that influences pregnant women’s view on the forthcoming labour and delivery. Midwives at antenatal care clinics, compared to colleagues working at labour wards, experience a greater need for training in care of pregnant women with severe FOC. Self-efficacy is a useful construct and the self-efficacy theory an applicable way of thinking in analysing fear of childbirth. The self-efficacy concept might be appropriate in midwives’ care for women with severe FOC.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. , 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1334
Keyword [en]
Anxiety; Childbirth; Content analysis; Fear; Focus-group interview; Midwives; Self-efficacy; Phenomenography; W-DEQ; CBSEI
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-85650ISBN: 978-91-7519-780-7 (print)OAI: oai:DiVA.org:liu-85650DiVA: diva2:572247
Public defence
2012-12-14, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-11-27 Created: 2012-11-27 Last updated: 2012-11-27Bibliographically approved
List of papers
1. Swedish midwives' perceptions of fear of childbirth
Open this publication in new window or tab >>Swedish midwives' perceptions of fear of childbirth
2010 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 3, 327-337 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: to describe midwives' experiences with, and perceptions of, women with fear of childbirth. DESIGN: a qualitative study with a phenomenographic approach. Data were collected by means of interviews in focus groups. SETTING: four focus groups at four types of hospital in Southern Sweden over a period of 18 months, 2004-2006. PARTICIPANTS: 21 experienced midwives. FINDINGS: four description categories emerged, i.e. appearance of fear of childbirth, origins of fear of childbirth, consequences of fear of childbirth, and fear of childbirth and midwifery care. KEY CONCLUSION: fear of childbirth is seen as a continuum from normal to irrational, severe fear. It has various origins which are more or less difficult to operationalise. Fear of childbirth influences the experience of pregnancy, the labour process and the transition to parenthood. Midwifery care of women with fear of childbirth is emotionally demanding and time consuming. Aspects of care required early identification of women with fear of childbirth, individual care, preparation for giving birth, support of a companion during labour, and postpartum follow-up.  

Keyword
Fear of childbirth; Midwives; Focus group interview; Care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43572 (URN)10.1016/j.midw.2008.07.003 (DOI)000278029000009 ()18774630 (PubMedID)74247 (Local ID)74247 (Archive number)74247 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2012-11-27
2. Swedish midwives’ views on severe fear of childbirth
Open this publication in new window or tab >>Swedish midwives’ views on severe fear of childbirth
2011 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 4, 153-159 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To describe the views of Swedish midwives on severe fear of childbirth (SFOC).

Study design

In this cross sectional study, a random sample of 1000 midwives, selected from the database of the Swedish Association of Midwives, received a questionnaire. The response rate was 84% (n = 834), with 726 questionnaires included in the final analysis.

Main outcome measures

The views of midwives on SFOC in different contexts of work: antenatal care clinic (ACC), labour ward (LW) either ACC/LW or Neither-Nor ACC/LW.

Results

The majority of respondents thought that the frequency of SFOC has increased during the last 10 years (67%), and that pregnant women today are more likely to discuss their fears (70%). Midwives at ACCs thought that special education in SFOC is needed (p < 0.001) and that they have more responsibility to identify women with SFOC (p < 0.001) than midwives at LWs. The majority of respondents, both at ACCs (60%) and LWs (65%), intuitively sensed when they were meeting a woman with SFOC. Opinions among midwives who alternate between working in ACCs and LWs reflected the views of the midwives working either in an ACC or an LW.

Conclusions

The views of midwives on SFOC are partly in concordance and partly contradictory in relation to the different workplaces as well as research data. Knowledge of the views of midwives on SFOC is a necessary pre-requisite to improve care for pregnant women.

Keyword
Anxiety, Fear of childbirth, Midwives, Views
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-73549 (URN)10.1016/j.srhc.2011.07.002 (DOI)
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-12-08Bibliographically approved
3. Self-efficacy beliefs and fear of childbirth in nulliparous women
Open this publication in new window or tab >>Self-efficacy beliefs and fear of childbirth in nulliparous women
2013 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, no 3, 116-121 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To explore how childbirth self-efficacy, i.e. outcome expectancy and efficacy expectancy, was associated with fear of childbirth (FOC) and how efficacy expectancy and FOC, respectively were related to socio-demographic characteristics, mental problems and preference for a caesarean section.

Methods: In this cross-sectional study, a consecutive sample of 1000 pregnant nulliparous women was sent the Wijma Delivery Expectancy Questionnaire and Childbirth Self-Efficacy Inventory. Statistical analyses were performed on data from 423 women.

Results: Outcome expectancy and efficacy expectancy correlated significantly and positively, FOC correlated significantly and negatively with both outcome expectancy and efficacy expectancy. Women with severe FOC (20.8%) had a significantly lower level of education (p = 0.001), and had more often sought help because of mental problems (p = 0.004). They were more likely to have low-efficacy expectancy (p < 0.001) and to prefer a caesarean section instead of a vaginal birth (p < 0.001).

Conclusions: Lower efficacy expectancy was associated with higher FOC while preference for a caesarean section was not. Improvement of self-efficacy could be a part of care for women with FOC during pregnancy; however, it would not be enough for fearful women who wish to have a caesarean section.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keyword
Caesarean section, CBSEI, Fear of childbirth, Self-Efficacy, W-DEQ
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-85647 (URN)10.3109/0167482X.2013.824418 (DOI)000323332400004 ()
Available from: 2012-11-27 Created: 2012-11-27 Last updated: 2017-12-07Bibliographically approved
4. Self-efficacy in pregnant women with severe fear of childbirth
Open this publication in new window or tab >>Self-efficacy in pregnant women with severe fear of childbirth
2013 (English)In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 2, 191-202 p.Article in journal (Other academic) Published
Abstract [en]

Objective: To apply and test the concept of childbirth self-efficacy to expectations of the upcoming birth in the context of severe fear of childbirth (SFOC).

Design: Qualitative study using semi-structured interviews.

Setting: A region in the southeast of Sweden

Participants: Nulliparous pregnant women (n=17) with SFOC.

Method: The interviews were analysed according to content analysis, using deductive and inductive approaches. The seven domains of the childbirth self-efficacy inventory (CBSEI) made up the matrix for the deductive analysis.

Results: Behaviours for coping with labour and childbirth were related to six domains of childbirth self-efficacy; “concentration”, “support”, “control”, “ motor/relaxation”, “selfencouragement” and “breathing”. Most of these behaviours referred to capabilities to carry out (self-efficacy expectancy) rather than to beliefs in effectiveness (outcome expectancy). Five additional sub-domains representing defined childbirth self-efficacy were identified; “guidance”, “the body controls”, “the professionals´ control”, “reliance” and ‘fatalism’.

Conclusion: The domains of childbirth self-efficacy have been deepened and expanded in relation to SFOC. It is imperative to identify pregnant women with SFOC and their efficacy beliefs in order to help them find appropriate coping behaviours prior to the onset of labour, and furthermore these behaviours must be supported by healthcare professionals during labour and childbirth. Support in the form of verbal persuasion emanating from the subdomains of childbirth self-efficacy ought to be added.

Place, publisher, year, edition, pages
John Wiley & Sons, 2013
Keyword
CBSEI, content analysis, fear of childbirth, qualitative study, self-efficacy
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-85649 (URN)10.1111/1552-6909.12024 (DOI)000316279500010 ()
Available from: 2013-04-12 Created: 2012-11-27 Last updated: 2017-12-07Bibliographically approved

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