The Effects of Antenatal Education and Counseling on Childbirth Fear of Nulliparous Women

Study Overview
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Brief Summary
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This study investigates the effects of antenatal education and counseling on childbirth preparation and pain management given to nulliparous women during the last trimester on their childbirth fear and childbirth attitudes.

Detailed Description
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Pregnancy is an important period of life that the pregnant women have biological, physiological, emotional and social changes in order to adapt to maternity. Fear of childbirth is a common problem and has a negative impact on the childbirth experience. The prevalence of fear associated with childbirth is around 20% but approximately 6 to 10% of women experience intense fear of labour. In Turkey, it estimated that the prevalence of childbirth fear among the Turkish pregnant women was approximately 21% . Fear of childbirth can cause significant problems during childbirth and the postpartum period. This fear is commonly associated with concern for the baby, pain in childbirth, longer first and second stage of labour and dissatisfaction with the childbirth experiences. Especially nulliparous women experience fear of childbirth more than multipar women. Fear of childbirth has also been implicated in women's requests for caesarean sections and increased rate of elective caesarean sections. Antenatal education is an essential health service throughout the world. Antenatal education during the last trimester may decrease childbirth fear. Also, pregnant women who received antenatal education, had a positive birth experience, better maternal adjustment and fewer symptoms of postnatal depression. The aim of this study was to investigate the effects of antenatal education and counseling on childbirth preparation and pain management given to nulliparous women during the last trimester on their childbirth fear and childbirth attitudes. This randomized controlled study was conducted at Gulhane Training and Research Hospital, Obstetrics and Gynecology clinic between February 2016 and January 2017. 132 nulliparous women between the 28th and 34th gestational weeks constituted the sample of the study. Data was collected by using personal information questionnaire, the Wijma Delivery Expectancy/Experience Questionairre (W-DEQ) Version A, W-DEQ Version B, and Childbirth Attitudes Questionairre (CAQ). Following the pretest, participants in the intervention group received childbirth preparation education and telephone counseling. Participants in the control group received no intervention other than the routine antenatal follow-up. For both groups, pretest and posttest were conducted during the same days, antenatal evaluation took place between the 38th and the 40th gestational weeks and postnatal evaluation was conducted during the first and the second postnatal days. The IBM SPSS (Statistical package for the Social Sciences) 22.0 package program was used to evaluate the data obtained in the study.

Official Title
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The Effects of Antenatal Education and Counseling on Childbirth Fear of Nulliparous Women and Their Attitudes Towards Childbirth

Conditions
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Fear of Childbirth

Intervention / Treatment
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* Behavioral: Education and Counseling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Nulliparity 28-34th gestational age Single fetus not receive IVF treatment Normal vaginal birth Exclusion Criteria: Caesarean section

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This randomized controlled study was conducted at Gulhane Training and Research Hospital, Obstetrics and Gynecology clinic between February 2016 and January 2017. The CONSORT (Consolidated Standards of Reporting Trials) guidelines for reporting randomised controlled trials (RCTs) has been used to describe the methods.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Pregnant women in intervention group completed the PIQ, W-DEQ-A and CAQ between the 28th and the 34th gestational weeks. Date of the next antenatal follow-up of the participants in the intervention group was recorded and they were given an appointment for the antenatal education. Women, whose date of next antenatal follow-up was unknown, were asked to inform the researchers about their appointment. Following the antenatal follow-up, the pregnant women in the intervention group were given an antenatal childbirth education and an educational brochure after the education. Also, provided telephone counseling to the intervention group one week after the education. Participants in the intervention group filled the W-DEQ-A and CAQ during the 38th and the 40th gestational weeks. Finally, were completed the W-DEQ-B during the first and the second postnatal days. | Behavioral: Education and Counseling<br>* Following the pretests between the 28th and the 34th gestational weeks, nulliparous women in the intervention group received a presentation on childbirth preparation at a room of the obstetrics clinic. The education was completed in two sections in a single day. Each session took about 45 minutes there was a 15-minute break between the sessions. Following the education, the questions of the participants were responded and educational brochures on childbirth preparation were given to the participants. One of the researchers of this study telephoned the participant women in the intervention group one week after the childbirth education and provided counseling service about the demands and the points that the nulliparous women wondered.<br>|
| No Intervention: Control<br>Pregnant women in control group completed the PIQ, W-DEQ-A and CAQ between the 28th and the 34th gestational weeks. Participants in the control group filled the W-DEQ-A and CAQ during the 38th and the 40th gestational weeks. Finally, were completed the W-DEQ-B during the first and the second postnatal days. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Wijma Delivery Expectancy/Experience Questionairre (Version A) (W-DEQ-A) | Participants filled before and after education and counseling W-DEQ-A was developed by Klaas and Barbro Wijma in Sweden in 1998. Cronbach's alpha of the scale was 0.88 for primiparous women. The scale consisted of 33 items, which are rated on a six-point Likert type scale (zero=do not agree; five=totally agree). Items 2, 3, 6, 7, 8, 11, 12, 15, 19, 20, 24, 25, 27 and 31 were reverse-scored to calculate the women's individual total score. Higher scores indicated greater fear that the pregnant women experienced. Cutting score of the questionnaire was 85. | 10 minutes | 
| Wijma Delivery Expectancy/Experience Questionairre (Version B) (W-DEQ-B) | Participants filled on the first and second days of postpartum W-DEQ-B was developed by Klaas and Barbro Wijma in 1998 in order to determine postpartum pains and the feelings and thoughts of women after childbirth. The questionnaire included 32 items rated on a six-point Likert type scale (zero=not at all; five=extremely). Items 2, 3, 6, 7, 10, 11, 14, 18, 19, 23, 24, 26, and, 30 were reverse scored and higher scores indicated greater postnatal fear of childbirth. The questionnaire had six subscales, namely, concerns about labor pain, loneliness, lack of positive feelings, concerns about childbirth, and concerns about baby. | 10 minutes | 
| Childbirth Attitudes Questionnaire (CAQ) | Participants filled before and after education and counseling CAQ was developed by Lowe in 2000 in order to measure the fear of childbirth. Cronbach's alpha of the scale was 0.83. The questionnaire included 16 items rated on a four-point Likert type scale. Higher scores indicated greater fear. | 5 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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attitude, childbirth, nulliparous, childbirth fear, antenatal education, counseling, pain