Fear of childbirth in Iran: A systematic review of psychological intervention research

Azizi, Marzieh; Kamali, Mahsa; Elyasi, Forouzan; Shirzad, Mahboobeh

doi:10.18502/ijrm.v19i5.9250

Cited by 10 publications

(15 citation statements)

References 39 publications

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“…The SRs in the study between 2018 and 2023 in the countries of Iran [ 8 – 10 , 12 , 25 , 26 , 41 ], Spain [ 42 ], Turkey [ 6 ], Australia [ 43 ], Singapore [ 33 ], United Kingdom [ 44 , 45 ], Canada [ 46 ] and Nigeria [ 47 ] have been carried out. Among these SRs, the study of Azizi et al [ 8 ] has been conducted on the trials carried out in Iran and the study of Tola et al [ 47 ] has been conducted on trials conducted in low- and middle-income countries. The number of trials included in these SRs varied from seven [ 6 , 44 , 46 ] to 63 [ 9 ] and the number of participants from 728 [ 25 ] to 11,185 [ 9 ].…”

Section: Resultsmentioning

confidence: 99%

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The effect of non-pharmacological prenatal interventions on fear of childbirth: an overview of systematic reviews and meta-analysis

Alizadeh-Dibazari,

Maghalain,

Mirghafourvand

2024

BMC Psychiatry

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Background During pregnancy and childbirth, alongside positive feelings, women undergo feelings such as fear of childbirth (FoC) and worry about its consequences, which could leave negative effects on the mother and her child during pregnancy, delivery, and postpartum. The study was carried out to determine the effectiveness of prenatal non-pharmacological interventions on reducing the FoC. Methods The protocol of the study was registered in PROSPERO (ID: CRD42023468547). PubMed, Web of Science, Cochrane, Scopus, SID (Scientific Information Database) and Google Scholar search engine databases were systematically searched until July 27, 2023 with no limitation of time and limited to Persian and English studies in order to perform this overview. Certainty of evidence was assessed using GRADE, methodological quality using AMSTAR 2 and reporting quality using PRISMA score. Meta-analysis was performed on the data extracted from the original trials to evaluate the effect of different interventions on reducing the FoC. Sub-group analysis and meta-regression models were used to examine high heterogeneity, and sensitivity analysis was used to eliminate the effect of high risk of bias studies on the study findings. Results Overall, 15 systematic reviews (SRs) were included in the overview, among which meta-analysis was performed in 9 studies. Considering methodological quality, these SRs were in low to critically low status and had relatively complete reports regarding reporting quality. Meta-analysis findings indicated that psychological interventions (SMD -2.02, 95% CI -2.69 to -1.36, 16 trials, 1057 participants, I2 = 95%) and prenatal educations (SMD -0.88, 95% CI -1.16 to -0.61, 4 trials, 432 participants, I2 = 72.8%) cause a significant reduction in FoC relative to prenatal usual cares with low certainty of evidence. Distraction techniques lead to a significant reduction in FoC relative to prenatal usual care with high certainty of evidence (SMD -0.75, 95% CI -1.18 to -0.33, 4 trials, 329 participants, I2 = 69%), but enhanced cares do not result in a significant decrease FoC relative to prenatal usual care with very low certainty of evidence (SMD -1.14, 95% CI -2.85 to 0.58, 3 trials, 232 participants, I2 = 97%). Conclusions Distraction techniques are effective in reducing FoC. Regarding the effect of psychological interventions and prenatal educations on the reduction of FoC, the findings indicated that the interventions may result in the reduction of FoC. Very uncertain evidence showed that enhanced cares are not effective in reducing the FoC.

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Section: Resultsmentioning

confidence: 99%

“…These differences could be because of general ignorance about FoC and its risk factors that results in the use of various measurement tools or even different cut points in the same tool [ 2 ]. Moreover, the prevalence of FoC could vary in various cultures and countries [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of non-pharmacological prenatal interventions on fear of childbirth: an overview of systematic reviews and meta-analysis

Alizadeh-Dibazari,

Maghalain,

Mirghafourvand

2024

BMC Psychiatry

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“… National health system level Implementation of pain relief during childbirth guidelines The provision of childbirth pain relief methods is another strategy for promoting vaginal childbirth in Iran, which was implemented to make childbirth pleasant and to increase women's satisfaction. However, evidence shows that in public hospitals, pregnant women do not have access to pain relief options (mostly non-pharmacological) during labour [ 11 , 41 ]. RMC Respectful Maternity Care, MOHME Ministry of Health and Medical Education, MHCPs Maternity Healthcare Providers …”

Section: Methodsmentioning

confidence: 99%

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research

Mirzania,

Shakibazadeh,

Bohren

et al. 2024

Reprod Health

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Background Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). Methods An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). Conclusions This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges.

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“…The provision of childbirth pain relief methods is another strategy for promoting vaginal childbirth in Iran, which was implemented to make childbirth pleasant and increase satisfaction of women. However, evidence show that in public hospitals, pregnant women do not have access to pain relief interventions during labour [11,32]. We conducted an exploratory qualitative study consisting of individual in-depth and semi-structured interviews between July 2022 and February 2023 in Tehran, Iran.…”

Section: Implementation Of Painless Childbirth Guidelinesmentioning

confidence: 99%

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the consolidated framework for implementation research

Mirzania

Shakibazadeh

Babaey³

et al. 2023

Preprint

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Background: Mistreatment during childbirth is a growing concern worldwide, especially in developing countries such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experience in the birth facilities. In this study, we identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the consolidated framework for implementation research (CFIR). Methods: An exploratory qualitative study involving thirty in-depth and semi-structured interviews was conducted between July 2022 and February 2023. Participants include a purposive sample of key informants at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results: The identified challenges were: (1) Individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companion: e.g., patient needs and resources, structural characteristics, culture); (2) Healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) Hospital level (evaluating the performance of maternity healthcare providers: e.g., external policies and incentives, executing); and (4) National health system level (implementation of painless childbirth guidelines: e.g., networks and communications, knowledge and beliefs about the intervention, executing, reflecting and evaluating). Conclusions: This study shows a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth; and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise in the implementation of their current programs and policies regarding the quality of maternity care by focusing on identified challenges.

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Fear of childbirth in Iran: A systematic review of psychological intervention research

Cited by 10 publications

References 39 publications

The effect of non-pharmacological prenatal interventions on fear of childbirth: an overview of systematic reviews and meta-analysis

The effect of non-pharmacological prenatal interventions on fear of childbirth: an overview of systematic reviews and meta-analysis

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the consolidated framework for implementation research

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