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Background Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education. Methods This study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n  = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL) : Working with Pain in Childbirth , based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected. Results In a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls. Conclusions This study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects. Trial registration The ClinicalTrials.gov identifier for the PEARLS  study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Abusive treatment of women during childbirth has been documented in low-resource countries and is a deterrent to facility utilization for delivery. Evidence for interventions to address women's poor experience is scant. We assessed a participatory community and health system intervention to reduce the prevalence of disrespect and abuse during childbirth in Tanzania. We used a comparative before-and-after evaluation design to test the combined intervention to reduce disrespect and abuse. Two hospitals in Tanga Region, Tanzania were included in the study, 1 randomly assigned to receive the intervention. Women who delivered at the study facilities were eligible to participate and were recruited upon discharge. Surveys were conducted at baseline (December 2011 through May 2012) and after the intervention (March through September 2015). The intervention consisted of a client service charter and a facility-based, quality-improvement process aimed to redefine norms and practices for respectful maternity care. The primary outcome was any self-reported experiences of disrespect and abuse during childbirth. We used multivariable logistic regression to estimate a difference-in-difference model. At baseline, 2,085 women at the 2 study hospitals who had been discharged from the maternity ward after delivery were invited to participate in the survey. Of these, 1,388 (66.57%) agreed to participate. At endline, 1,680 women participated in the survey (72.29% of those approached). The intervention was associated with a 66% reduced odds of a woman experiencing disrespect and abuse during childbirth (odds ratio [OR]: 0.34, 95% CI: 0.21-0.58, p < 0.0001). The biggest reductions were for physical abuse (OR: 0.22, 95% CI: 0.05-0.97, p = 0.045) and neglect (OR: 0.36, 95% CI: 0.19-0.71, p = 0.003). The study involved only 2 hospitals in Tanzania and is thus a proof-of-concept study. Future, larger-scale research should be undertaken to evaluate the applicability of this approach to other settings. After implementation of the combined intervention, the likelihood of women's reports of disrespectful treatment during childbirth was substantially reduced. These results were observed nearly 1 year after the end of the project's facilitation of implementation, indicating the potential for sustainability. The results indicate that a participatory community and health system intervention designed to tackle disrespect and abuse by changing the norms and standards of care is a potential strategy to improve the treatment of women during childbirth at health facilities. The trial is registered on the ISRCTN Registry, ISRCTN 48258486. ISRCTN Registry, ISRCTN 48258486.

Background High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention. Method Between May 2012 and June 2013 women in their second trimester of pregnancy were recruited. Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Questionnaire (W-DEQ) were randomised to receive telephone psycho-education by a midwife, or usual maternity care. A two armed non-blinded parallel (1:1) multi-site randomised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic centralised computer service. The outcomes of the RCT on obstetric outcomes, maternal psychological well-being, parenting confidence, birth satisfaction, and future birth preference were analysed by intention to treat and reported here. Results 1410 women were screened for high childbirth fear (W-DEQ ≥66). Three hundred and thirty-nine ( n  = 339) women were randomised (intervention n  = 170; controls n  = 169). One hundred and eighty-four women (54 %) returned data for final analysis at 6 weeks postpartum (intervention n  = 91; controls n  = 93). Compared to controls the intervention group had a clinically meaningful but not statistically significant reduction in overall caesarean section (34 % vs 42 %, p  = 0.27) and emergency CS rates (18 % vs 25 %, p  = 0.23). Fewer women in the intervention group preferred caesarean section for a future pregnancy (18 % vs 30 %, p  = 0.04). All other obstetric variables remained similar. There were no differences in postnatal depression symptoms scores, parenting confidence, or satisfaction with maternity care between groups, but a lower incidence of flashbacks about their birth in the intervention group compared to controls (14 % vs 26 %, p  = 0.05). Postnatally women who received psycho-education reported that the ‘decision aid’ helped reduce their fear (53 % vs 37 %, p  = 0.02). Conclusion Following a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy. A reduction in overall CS rates was also found. Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies. Trial registration Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17th May 2012

Purpose This study was applied to evaluate the effect of birth ball use on birth satisfaction and pain levels of pregnant women during labor. Methods The type of study is randomized controlled. The data of the study were collected in the delivery room of a state hospital in Konya/Türkiye between March 2020 and December 2021. The sample of the study consisted of 57 pregnant women for the intervention group and 54 pregnant women for the control group. During labor, intervention group was seated on the birth ball in an upright position; control group was laid on the bed in semi-fawler or lateral positions. In the study, Descriptive Information Form, Birth Process Follow-up Form, Visual Analog Scale and Birth Satisfaction Scale-Revised were used as data collection tools. Results It was determined that the pain scores of the pregnant women in the intervention group were lower during the first and second follow-up than the control group. The duration of the active phase of labor in the intervention group was shorter than in the control group, and a statistically significant difference was found between them. It was found that the Birth Satisfaction Scale-Revised total score, the sub-dimensions of quality of care, women’s attributes and stress experienced during labor of the pregnant women in the intervention group were higher than the control group. Conclusion According to the results of the study, the use of a birth ball during the active phase of labor reduces the pain level during labor and increases the level of birth satisfaction of pregnant women.

Background Assessing women’s childbirth experiences is a crucial indicator in maternity services because negative childbirth experiences are associated with maternal mortalities and morbidities. Due to the high caesarean birth rate in Iran, measuring childbirth experience is a top priority, however, there is no standard tool to measure this key indicator in Iran. The aim of present study is to adapt the “Childbirth Experience Questionnaire 2.0” to the Iranian context and determine its psychometric characteristics. Methods Childbirth Experience Questionnaire 2.0 was translated into Farsi. A total of 500 primiparous women, at 4 to 16 weeks postpartum, were randomly selected from 54 healthcare centres in Tabriz. Internal consistency and reliability was calculated using the Cronbach’s Coefficient alpha and Intraclass Correlation Coefficient, respectively. Construct validity was assessed using exploratory and confirmatory factor analysis and discriminant validity using the known-group method and the Mann-Whitney U-test. Results The internal consistency and reliability for the total tool were high (Cronbach’s alpha = 0.93; Intraclass Correlation Coefficient = 0.97). Explanatory factor analysis demonstrated the adequacy of the sampling (Kaiser-Meyer-Olkin = 0.923) and significant factorable sphericity ( p  < 0.001). Confirmation factor analysis demonstrated acceptable values of fitness (RMSEA = 0.07, SRMSEA = 0.06, TLI = 0.97, CFI > 0.91, x 2 / df = 4.23). Discriminatory validity of the tool was confirmed where the CEQ score and its subdomains were significantly higher in women who reported having control over their childbirth than women who did not. Conclusion The Farsi version of the Childbirth Experience Questionnaire 2.0 tool is a valid and reliable tool and can be used to measure the childbirth experience in Iranian women.

Background and aim Telling stories about giving birth vaginally can generate deeper understandings, potentially resulting in fewer requests to birth via cesarean section without medical reason. We aimed to determine the impact of the digital storytelling of peers’ childbirth experiences on the perception and mode of childbirth in those birthing for the first time. Methods This quasi-experimental study invited those pregnant and birthing for the first time from four comprehensive health centers to participate. Using a simple randomizing method, two centers were assigned to the control group and two centers were assigned to the intervention group. Convenience sampling was used to recruit 65 eligible participants from each center group. The six steps of the ASPIRE model were used to guide the development of the intervention. Five story-telling videos were sent weekly to participants in the intervention group to watch between the 32nd and 36th weeks of pregnancy. After giving birth, data were collected via telephone from those in both the control and intervention groups in relation to their mode of childbirth as a primary outcome. Furthermore, 7 to 21 days after giving birth, all participants completed the Childbirth Perception Scale as a primary outcome. Results Our subgroup analysis confirmed a statistically significant difference between both the intervention and control groups ( P  = 0.001), whereby those who gave birth vaginally in the intervention group indicated more positive perceptions of childbirth. Contrariwise, no significant difference was identified between the intervention and control groups in terms of perception of childbirth score in participants who gave birth via emergency cesarean section ( P  = 0.45). In all included participants, that is, those who experienced vaginal childbirth and those who experienced emergency cesarean section, there was no significant difference identified between the intervention and control groups in terms of perception of childbirth score ( P  = 0.088). Conclusion The digital storytelling of peers’ childbirth experiences is effective in cultivating more positive perceptions in relation to the experience of childbirth, specifically among those who experience childbirth vaginally. Considering the above, digital storytelling may be implemented as a useful tool in childbirth preparation, though the need for alternative interventions remains in pursuit of lowering the number of unnecessary births via cesarean section conducted overall.

Background Approximately 25 % of pregnant women suffer from a high level of Fear of Childbirth (FoC), as assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A, score ≥66). FoC negatively affects pregnant women’s mental health and adaptation to the perinatal period. Mindfulness-Based Childbirth and Parenting (MBCP) seems to be potentially effective in decreasing pregnancy-related anxiety and stress. We propose a theoretical model of Avoidance and Participation in Pregnancy, Birth and the Postpartum Period in order to explore FoC and to evaluate the underlying mechanisms of change of MBCP. Methods/Design The ‘I’ve Changed My Mind’ study is a quasi-experimental controlled trial among 128 pregnant women (week 16–26) with a high level of FoC, and their partners. Women will be allocated to MBCP (intervention group) or to Fear of Childbirth Consultation (FoCC; comparison group). Primary outcomes are FoC, labour pain, and willingness to accept obstetrical interventions. Secondary outcomes are anxiety, depression, general stress, parental stress, quality of life, sleep quality, fatigue, satisfaction with childbirth, birth outcome, breastfeeding self-efficacy and cost-effectiveness. The total study duration for women is six months with four assessment waves: pre- and post-intervention, following the birth and closing the maternity leave period. Discussion Given the high prevalence and severe negative impact of FoC this study can be of major importance if statistically and clinically meaningful benefits are found. Among the strengths of this study are the clinical-based experimental design, the extensive cognitive-emotional and behavioural measurements in pregnant women and their partners during the entire perinatal period, and the representativeness of study sample as well as generalizability of the study’s results. The complex and innovative measurements of FoC in this study are an important strength in clinical research on FoC not only in pregnant women but also in their partners. Trial registration Dutch Trial Register (NTR): NTR4302 , registration date the 3rd of December 2013.

Background Empathic communication during childbirth can improve women’s birth perception and reduce fear and trauma, yet evidence on its effects across diverse populations is limited. This study addresses this gap by examining its impact on primiparous women’s psychological outcomes, providing evidence to support holistic maternity care.Thus, this randomized controlled trial examined the effect of empathic communication-based training on women’s awareness, positive perception of birth, and overall birth experience. Methods Between June 2023 and September 2024, 72 pregnant women attending the obstetrics and gynecology outpatient clinics of Kahramanmaraş Necip Fazıl City Hospital, Turkey, were randomly assigned to intervention or control groups. The intervention, an empathic communication-based training, was developed and delivered by the researchers. The study included three stages: development of the Positive Birth Perception and Awareness Scale (PBPAS), creation of the Empathic Communication-Based Positive Birth Guide, and assessment of group differences. Data were collected using the Prenatal Demographic Form, PBPAS, and the Wijma Delivery Expectancy/Experience Questionnaire-A (WDEQ-A). Statistical analyses included chi-square tests and independent and paired t-tests, with results reported alongside 95% confidence intervals. Results The PBPAS demonstrated high reliability. In the intervention group, PBPAS scores increased significantly from 68.24 ± 7.12 to 85.36 ± 6.48 ( p  < 0.001), while the control group showed no significant change (69.12 ± 8.03 to 71.45 ± 7.89, p  = 0.08). WDEQ-A scores decreased significantly in the intervention group (80.45 ± 9.32 to 65.88 ± 10.12, p  < 0.001) and increased in the control group (74.16 ± 8.54 to 79.88 ± 12.24, p  = 0.02). Conclusion Empathic communication improves primiparous women’s psychological outcomes and birth experiences. Future studies should assess its long-term effects, and healthcare systems should integrate empathic communication training to support holistic maternity care.

Introduction Childbirth may be associated with psychological, social, and emotional effects and provide the background for women’s health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression. Materials and method This randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh’s postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention. Results The mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p  = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p  = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p  = 0.01). Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022. Conclusion The study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.