A Study to Assess Childbirth Related Fear and Associated Factors among Third Trimester Primigravida Mothers Visiting Antenatal Clinic in a Selected Hospital of Mangalore

 

Raina Roopal Menezes, Mrs Sandhya D’almeida

Laxmi Memmorial College of Nursing, (RGUHS), Mangalore

 

ABSTRACT:

The most important period for a woman is her growth into parenthood. Becoming a mother is an important stage in every woman’s life. Childbirth is a natural, normal and a life changing event. It usually begins spontaneously about 280 days after conception Tokophobia or fear of childbirth has become a modern day epidemic amongst pregnant women .It affects at least one in every ten women. A variable number of 20% to 78% of pregnant women report fear associated with pregnancy and childbirth. However 13% of non-gravida women report fear of childbirth to postpone or avoid pregnancy. Though pregnancy is a wonderful and joyful event in most women’s life, many women have emotional disturbances because of the physical change in them and the process of childbirth .Fear is a distressing emotion induced by a perceived threat and is one thing that has been a common threat throughout the first pregnancy period. Tokophobia can be caused by various different factors including fear of pain, past experience of a difficult childbirth, depression and even sexual trauma. Nurses play an important role to identify the level of fear and find out the associated factors to help mothers to overcome fear.

 

Aim:

The aim of the study is to assess the childbirth related fear and associated factors among third trimester primigravida mothers visiting antenatal clinic in a selected hospital of Mangalore.

 

Objectives of the Study:

1.      To determine the level of childbirth related fear among third trimester primigravida mothers visiting antenatal clinics.

2.      To determine associated factors responsible for childbirth related fear among third trimester primigravida mothers visiting antenatal clinics.

3.      To find the relationship between the childbirth related fear and associated factors among third trimester primigravida mothers visiting antenatal clinics.

4.      To find the association of childbirth related fear level and the selected demographic variables.

5.      To find the association of the associated factors responsible for childbirth related fear and the selected demographic variables.

 

Method:

The research approach used for the study was descriptive survey approach. The samples were selected by the non-probability, purposive sampling technique. The study was conducted in Lady Goshen Government hospital, Mangalore from 1.10.2013 to 31.10.13. The data was collected by using demographic proforma, fear rating scale & check list. The data collected was analyzed to achieve the objectives of the study and to test the research hypotheses using the descriptive and inferential statistics.

 

Results:

Analysis of childbirth related fear revealed that the highest percentage (98%) of the third trimester primigravida mothers had ‘extreme fear’ on childbirth, and (2%) of them had ‘moderate fear’. Majority (95%) of sample had ‘unfavourable influence’ of associated factors and (5%) had ‘favourable influence’. There was positive correlation (0.30) found between childbirth related fear level and associated factors among third trimester primigravida mothers at 0.05 level of significance. A significant association was found between childbirth related fear level and following demographic variables such as religion (χ² 8.25), employment status (χ² 5.69), and monthly income (χ² 14.58) .There was significant association between associated factors and following demographic variable such as age (χ² 5.11), supportive person during pregnant (χ² 1.31) and information regarding childbirth process (χ² 3.84).

 

Interpretation and Conclusion:

The findings of the study showed that there was a significant increase of childbirth related fear level among third trimester primigravida mothers and the highest percentage of unfavourable associated factors influence on fear.

 

Keywords:

 

 

INTRODUCTION:

“Women’s bodies have near-perfect knowledge of childbirth, it’s when their brains get involved that things can go wrong”

- Peggy Vincent

 

Pregnancy is a major physical, psychological as well as a social event in every woman’s life. Instead of being joyful and exciting, pregnancy may become a worrisome event in few women and these fears may assume a pathological dimension and becomes a medical disorder worth recognition and treatment. It is understandable that women may have some apprehension because of lack of experience and upcoming responsibilities of motherhood. Increasing awareness and education may make them knowledgeable and at the same time apprehensive regarding the morbid accompaniments of labour. Some amount of fear is rational and acceptable. Majority of women are able to cope up with these fears and anxieties by self help efforts, social support and help of medical attendants.¹

 

Fear related to pregnancy and childbirth is common. In woman emotional state could affect her pregnancy and its outcome, which deeply disturbs maternal emotions which produces a marked increase in the physical activity of the foetus. A variable number of 20% to 78% of pregnant women report fear associated with pregnancy and childbirth. However 13% of nongravida women report fear of childbirth sufficient to postpone or avoid pregnancy.¹

 

Pain experienced during labour is probably the most painful event in the lives of women. Environment itself influences mother’s experience of pain. Tension and stress resulting from pregnancy crisis and labour increases when the mother is hospitalized, which is concomitant with stressful situations and factors that affect pain perception during labour.²

 

The factors leading to fear of childbirth are broadly analysed as primary causes like biological factors which includes negative stories and fear of pain in labour which is associated with suffering, shame, feeling of loss of control, helplessness and lack of trust in obstetric staff, fear regarding total duration of labour, fear of being exhausted in labour room.³

 

Psychological causes leading to fear of childbirth are mainly caused due to previous traumatic events which lead to depression, anxiety, nightmares and low self-esteem, resulting in lower self-efficacy, implying that mother have little confidence in their ability to labour effectively, fear regarding the sex of baby and of the baby’s health condition. Personality causes leads to childbirth fear by developing feeling of helplessness, anxiety about parenthood, ability of performing household work after delivery, depressed regarding gaining excess weight and not getting adequate leisure time after delivery. Social factors mainly influence women who are young and need someone always to look after them, have a low educational level and poor social network or who express dissatisfaction with their parents, increasing financial needs of family and most worried regarding in –laws and societal reaction if baby born is congenital abnormal and cultural factors includes the medicalization of childbirth, horror stories being passed on, alarming information is predominantly disseminated by friends, family and the media, stories told by health professionals also have a strong explanatory power for causing fear.^3,4

 

BACKGROUND OF THE STUDY:

Pregnancy and childbirth are natural processes that a woman has undergone through the years. Its up to the woman to make it as a pleasant experience. It’s more important to remember that a happy mother is more likely to give birth for a happy baby. In any society family is the central nucleus of people and women form the backbone of it. Pregnancy is a major physical, psychological as well as a social event in every woman’s life. Instead of being a joyful and exciting time, pregnancy may become a worrisome event in few women and these fears may assume a pathological dimension and become a medical disorder worth recognition and treatment. ⁵

According to Ministry of Health & Family Welfare of Karnataka state census reports, total 65.1% of institutional normal full term vaginal deliveries, 34.1% of home deliveries, and 6.4% of normal vaginal deliveries by skilled personnel at home.⁶

 

The world health statistics (WHS), released on May 18, 2012 reports that 9% of all births in India were by caesarean section. The latest figure has gone up by 5% since nearly one in 10 women in India, who gave birth between 2005 and 2010, had gone under the surgical knife. President of the Federation of Obstetrics and Gynaecology Societies of India, Dr. P. Shah said over last two decades, deliveries by caesarean section have increased by about 25% in teaching hospitals and by at least 50% in private hospitals. Several reasons have been seen an increase in caesarean sections in India the main reason was, first time mothers don’t want to undergo the pain of childbirth.⁷

 

STATEMENT OF THE PROBLEM:

A study to assess the childbirth related fear and associated factors among third trimester primigravida mothers visiting antenatal clinic in a selected hospital of Mangalore.

 

OBJECTIVES OF THE STUDY:

1.      To determine the level of childbirth related fear among third trimester primigravida mothers visiting antenatal clinics.

2.      To determine the associated factors responsible for childbirth related fear among third trimester primigravida mothers visiting antenatal clinics.

3.      To find the relationship between the childbirth related fear and the associated factors among third trimester primigravida mothers visiting antenatal clinics.

4.      To find the association of childbirth related fear level and the selected demographic variables.

5.      To find the association of the associated factors responsible for childbirth related fear and the selected demographic variables.

 

Assumptions:

The study assumes that:

·        Primigravida mothers may have some fear related to childbirth.

·        Childbirth related fear can be modified.

 

Delimitations:

The study is delimited to :

1      Third trimester primigravida mothers attending antenatal clinic in a selected hospitals of Mangalore.

 

Hypotheses:

The hypotheses will be tested at 0.05 level of significance

H₁:  There is a significant relationship between childbirth related fear and the associated factors.

H₂:  There is a significant association between the childbirth related fear level with the selected demographic variables.

H₃:  There is a significant association between the associated factors of childbirth related fear and the selected demographic variables.

 

RESEARCH METHODOLOGY:

Research approach:

The investigator utilized a descriptive survey approach in order to assess the childbirth related fear level among third trimester primigravida mothers.

 

Research design:

The research design selected for the present study is non experimental descriptive correlation study design.

 

Setting of the study:

The study was conducted in the antenatal clinic and antenatal ward of Govt. Lady Goshen hospital, Mangalore.

 

Population:

In the present study the population consists of third trimester primigravida mothers in Govt. Lady Goschen Hospital, Mangalore.

 

Sample:

The sample size is 100 third trimester primigravida mothers who are in third trimester.

 

Sampling technique:

Using non-probability purposive sampling technique, a sample of 100 third trimester primigravida mothers were selected.

 

Method of Data Collection:

Sampling criteria:

Inclusion criteria for sampling:

·        Primigravida mothers who are in age group of 18-40 years.

·        Primigravida mothers who are in third trimester.

·        Primigravida mothers willing to participate in study.

·        Who are able to read and write Kannada or English.

 

Exclusion criteria for sampling:

·        Mothers who are not willing to participate in the study.

·        Mothers who are illiterate.

 

Description of the tools:

Section A:

Demographic proforma consisted of 10 items regarding Age of the woman, Religion, Type of family, Educational status, Occupation, Monthly income, Gestational week, Most supportive person in the family, Any information regarding childbirth, If yes, by whom.

 

Section B:

Fear rating scale consisted of 31 items. The subjects were instructed to tick mark (ü) on the space provided towards the correct response. Each statement had 3 options (extreme fear, mild fear and no fear). Score of ‘zero’ was given for statements with ‘no fear,’ score of ‘one’ given to ‘mild fear’ and score of ‘two’ given to ‘extreme fear.’ The items were subdivided into sections which included fear related to labour process, fear related to painful procedures, fear related to unborn child, fear related to hospital environment. The scoring was done by just counting the scores of responses and according to the total score obtained. The highest possible score was 62. It was arbitrarily classified into three levels: [0=no fear, 1-31=mild fear, 32-62=extreme fear].

 

Section C:

Check list for the associated factors had 20 items and was subdivided into biological factors, psychological factors, personality factors and social factors. The options given were ‘yes’ or ‘no’. The highest possible score was 20. It was arbitrarily classified into two levels: [0-10-favorable score, 11-20- unfavourable score].

 

RESULTS:

The analyses of the data from the study are presented under the following headings:

Section A: Description of the sample according to their demographic variable.

Section B: Description of childbirth related fear level among third trimester primigravida mothers.

Section C: Description of the associated factors responsible for childbirth related fear among third trimester primigravida mothers.

Section D: Correlation between the childbirth related fear and the associated factors.

Section E: Association of childbirth related fear level among third trimester primigravida mothers and the demographic variables.

Section F: Association of the associated factors responsible for childbirth related fear and the demographic variables.

 

Section A: Description of the sample according to their demographic variable

Table 1: Frequency and percentage distribution of third trimester primigravida mothers according to their demographic variables

N=100

 

The data presented in table 1 shows the following findings;

Majority (58%) of the sample were in the age group of 23-27 years and the least (1%) percentage belonged to >33 years (33%). Highest percentage (48%) of the samples were of Hindus and least (7%) percentage were Christians .Majority (55%) of the sample belonged to nuclear family whereas the lowest percentage (45%) belonged to joint family. Majority (60%) of the samples had primary education and the least (1%) percentage had PUC and degree and above education. Highest percentage (55%) of the subjects were homemakers and the least (6%) were private employee. Majority (63%) of the subjects had a monthly family income of Rs 10,001-15,000 and the lowest (3%) had income less than Rs 5,000. Majority (67%) of the sample belonged to 34—36 weeks of gestation and the least (2%) were in between 28- 33 weeks of gestation. Majority (64%) of the subjects considered their mothers as the most supportive person during pregnancy period whereas the lowest percentage (2%) considered their in-laws as the most supportive person. The highest percentage (70%) of the subjects had no information regarding childbirth process and the least percentage (30%) had some information. The highest percentage (25%) of the subjects gained information from their elders and least from (5%) health professionals.

 

Section B: Description of childbirth related fear level among third trimester primigravida mothers

 

Figure 1: Cone diagram representing the percentage distribution of childbirth related fear level

 

Data presented in Figure 1 shows that 2% of third trimester pimigravida mothers were diagnosed to have ‘mild childbirth related fear’ and 98% had ‘severe childbirth related fear’ and none of them had ‘no fear’.

Section C: Description of associated factors responsible for childbirth related fear among third trimester primigravida mothers

 

Figure 2: Bar diagram representing the influence of associated factors on childbirth related fear

 

Data presented in Figure 2 shows that 5% of third trimester primigravida mothers had favourable influence of associated factors and (95%) mothers had unfavourable influence, respectively.

 

 

Table 2:Area-wise maximum possible score, range, mean, mean percentage and standard deviation of childbirth related fear score among third trimester primigravida mothers N=100

Data showed in table 2 show that (86.87%) of third trimester primigravida mothers had fear regarding painful procedures, (78.75%) had fear regarding labour process, (71.25%) had fear regarding hospital environment and (76.9%) had fear regarding health condition of the unborn child respectively.

 

Table 3: Area-wise description of score, mean, standard deviation and mean percentage of associated factors N=100

Sl. No.	Associated factors	Max score	Range	Mean	SD	Mean (%)
1.	Biological factors	4	1-4	3.41	0.85	85.25
2.	Psychological factors	6	2-6	4.64	1.20	77.33
3.	Personality factors	4	1-4	1.72	0.86	43.00
4.	Social factors	6	2-6	4.23	1.09	70.50

Data in Table3 shows (85.25%) of third trimester primigravida mothers had influence of biological factors, 77.33% of psychological factors, 70.5% of social factors, and 43% of personality factors, respectively.

 

Section D: Correlation between the childbirth related fear and the associated factors

H₀₁: There is no significant relationship between the childbirth related fear and the associated factors.

 

Table 4: Correlation between childbirth related fear level and associated factors among third trimester primigravida mothers.

N=100

*=significant

 

Karl Pearson’s correlation coefficient was computed in order to find the correlation between the childbirth related fear level and associated factors among third trimester primigravida mothers. The data presented in table 4 shows that there is a low positive correlation between the childbirth related fear level and the associated factors. Thus, if the influence of associated factors increases the childbirth fear level among third trimester primigravida also increases to some extent. So, the researcher failed to accept the null hypothesis H₀₁ at 0.05 level of significance.

 

Section E: Association between the level of childbirth related fear among third trimester primigravida mothers and the demographic variables

The following hypothesis was stated to find the association

H_02:  There is no significant association of childbirth related fear level with the selected demographic variables.

Table 5: Chi square test showing association between the childbirth related fear level with the demographic variables among third trimester primigravida mothers N=100

P < 0.05 S*=Significant p<0.05 NS=Not significant

As calculated chi square value of religion (χ²⁼8.25), employment status (χ²=5.69), monthly income (χ²=14.58), was more than the table value (3.841), and information regarding childbirth process (χ²=10.43) at 0.05 level of significance, hence null hypothesis is rejected.

 

The data in table shows that the calculated chi square for age (χ²=4.61), type of family (χ²=0.38), educational status (χ²=4.85), gestational age (0.86), most supportive person (χ²=0.49), and source of information (χ²=1.8) was less than the table value, hence null hypothesis is accepted.

 

Section F: Association between the associated factors responsible for childbirth related fear with the demographic variables

H₀₃: There is no significant association of associated factors with the selected demographic variables.

 

Table 6: Chi square test showing association between the associated factors with the demographic variables N=100

Sl. No.	Demographic characteristics	χ2 score	df	Table value	Inference
1.	Age	5.11	2	5.991	*S
2.	Religion	1.77	1	3.841	NS
3.	Type of family	1.63	1	3.841	NS
4.	Educational status	0.25	1	3.841	NS
5.	Employment status	3.38	2	5.991	NS
6.	Monthly income	0.66	1	3.841	NS
7.	Gestational age	1.17	2	5.991	NS
8.	The most supportive person during pregnancy and labour	1.31	1	3.841	*S
9(a)	Do you have any information regarding childbirth?	3.84	1	3.841	*S
9(b)	If yes, source of information	3.40	1	3.841	NS

P < 0.05 S*=Significant p<0.05 NS=Not significant

As the calculated chi square value of age (χ²=5.11) was more than the table value (5.991), it can be inferred that there was a significant association of age with the associated factors at 0.05 level of significance, thus research hypothesis is accepted and null hypothesis is rejected.

 

The data in table shows that the calculated chi square values were less than the table value for religion (χ²=1.77), type of family (χ²=1.63), educational status (χ²=0.25), employment status (χ²=3.38), monthly income (0.66), gestational age (χ²=1.17), most supportive person during childbirth (χ²=1.31), information regarding childbirth process(χ²=2.32), and source of information (χ²=3.4 ) Hence, the null hypothesis is accepted for these variables.

 

DISCUSSION:

Section A: Discussion of demographic characteristics of third trimester primigravida mothers:

The findings of the study can be compared with the study which was conducted to assess the childbirth related fear among primigravida mothers visiting antenatal clinics of Govt. Lady Goschen hospital Mangalore (Karnataka) also showed that majority of women (51.67%) belonged to age group 23-27 years ,highest percentage (63.33%) belonged to Hindu religion, highest percentage(85%) belonged to nuclear family.⁸

 

Section B: Discussion of level of childbirth related fear:

The study findings also can be compared to similar study conducted to do the assessment of the fear of delivery among women at labour at Baghdad university showed the following findings, a) fear of labour on mother herself: highest percentage (88.66%) had fear on episiotomy, 87% on fear of labour difficulties, 83.33% on being left alone in the labour room, 81% of fear of labour dystocia, 79.33% of fear of labour complications, 79% of fear on prolonged labour duration, and 78.33% of fear on exposure to infection during labour process; women fear on her newborn: highest percentage (87%) fear was on death on newborn, 84.66% on delivery of abnormal or unhealthy baby, 83.66% on foetal head dystocia, 82.66% on foetal asphyxia, 79.33% on foetal injury, and 78% on new born exposure to infection.⁹

 

Section C: Discussion of associated factors scores:

The findings of this study can be compared to a study conducted to assess the anxiety related to onset of labour and delivery among primigravida mothers , study showed (96.7%) of social aspect,(97.3%) of family aspect,(82%) of physical aspects,(98.7%) of psychological aspects respectively had their impact on childbirth fear.¹⁰

 

Section D: Discussion of correlation between childbirth related fear and the associated factors scores:

Results of this study can be compared with a study conducted to assess the anxiety related to onset of labour and delivery among primigravida mothers the level of anxiety and fear increased (46.4%) with SD (4.7%) only because of result of physical aspects (64.3%) compared to family aspects (45.8%), social aspects (39.2%) and psychological aspects(37.4%) respectively with significant but low positive (r=0.22) relationship between anxiety level and associated factors.¹¹

 

Section E: Discussion on the association of childbirth related fear level scores with the demographic variables:

The finding of the current study supports the study conducted in Mangalore to assess the fear level of childbirth among primigravida mothers visiting antenatal clinics of Govt. Lady Goschen Hospital, Mangalore, which showed a statistically significant association of the level of fear with religion (χ²⁼13.46, p<0.05).⁸

 

Section F: Discussion on the association of associated factors scores with the demographic variables:

These findings are supported by a study to assess the perceived environmental stressors and pain perception during labour among primi and multiparous mothers with statistically significant association of age with primiparous (r=0-16, p<0.01) and multiparous (r=0.22, p<0.05), respectively.²

 

CONCLUSION:

This study was conducted with the objective to assess the childbirth related fear and associated factors among third trimester primigravida mothers visiting antenatal clinic in a selected hospital of Mangalore.

 

Bibliography:

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2.       Manizheh P, Leila P. Percieved environmental stressors and pain perception during labour among primiparous and multiparous women. Journal of Reproductive Infertility 2009 Oct;10(3):217-23.

3.       Mehta A. Tokophobia: fear of pregnancy and childbirth. The Internet Journal of Gynaecology and Obstetrics 2008 Nov;10:1-2.

4.       Otley H. Fear of child birth; understanding the causes impact and treatment. The British Journal of Midwifery 2011 Apr;19(4):214-20.

5.       Julia A K. The development of maternal confidence for labour among nulliparous pregnant woman. [online]. Available from: URL:http://www.popularquotes.com

6.       Ministry of health and family welfare Karnataka report DIHS-3. [online]. Available from: URL:http://www.scribd.com

7.       Sinha K. Caesarean section accounts for 9% of all births in India. The Times of India: May 18, 2012. P. 5.

8.       Moras R. A study to assess the fear of childbirth among primigravidae mothers in selected maternity hospitals of Mangalore with a view to develop a need based information guide. Unpublished masters degree in nursing thesis, RGUHS, Mangalore; 2011.

9.       Rabea M. Assessment of the fear of delivery among women at labour. [online]. Available from:online-library-.fear-of-childbirth-among-low-socioeconomic-status.wiley.com.

10.     Subasheni G. A study to assess the anxiety related to onset of labour and delivery among primigravida mothers admitted for delivery at Vanivalas hospital, Bangalore; 2007.

 

 

Received on 22.05.2014           Modified on 12.07.2014

Accepted on 18.07.2014           © A&V Publication all right reserved