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Fear of Childbirth among Pregnant Women of Various Ethnicities Referring to Comprehensive Health Service Centers in Gorgan, Iran (2023)
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Fahimeh Tajari1    , Saba Poolaie2 , Fatemeh Mehravar3 , Akram Sanagoo *4 , Leila Jouybari5 |
1- B.A Student in Psychology, Member of Young Researchers Club, Faculty of Humanities, Gorgan Branch, Islamic Azad University, Gorgan, Iran.
2- B.Sc Student in Midwifery, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran.
3- Assistant Professor of Epidemiology, Ischemic Disorders Research Center, Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran.
4- Associate Professor in Nursing, Department of Nursing, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran. , sanagoo@goums.ac.ir
5- Professor in Nursing, Department of Nursing, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran. |
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Keywords: Pregnancy [MeSH], Prenatal Care [MeSH], Ethnicity [MeSH], Parturition [MeSH], Fear [MeSH], Delivery of Health Care [MeSH], Iran [MeSH]
Article ID: Vol27-19 |
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Type of Study: Original Articles |
Subject:
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Abstract: (39 Views) |
Extended Abstract
Introduction
The fear of childbirth can range from minor worries and anxieties about childbirth to an intense phobia, significantly impacting women's lives, causing distress, and affecting their psychological well-being. Tocophobia is a severe anxiety condition that drives women to fear, and consequently leads women to avoid pregnancy and childbirth despite a strong desire to have children. Tocophobia is classified as an unspecified phobic anxiety disorder in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) published by the World Health Organization (WHO). Diagnostic criteria for tocophobia include severe anxiety and worry regarding childbirth (increasing in the third trimester of pregnancy), difficulty controlling these worries, and impaired concentration during professional or family activities. These criteria, along with at least three symptoms, including fear of pain, fear of inability to give birth to the baby, physical disorders, nightmares, avoidance of being in frightening situations (such as avoiding pregnancy, terminating pregnancy, or requesting a cesarean section without medical indication), and severe restlessness or weaknessfrom, are crucial for tocophobia diagnosis.
One in five pregnant women experiences fear of childbirth, with approximately 6% to13% of pregnant women experiencing severe and debilitating fear. The causes of fear of childbirth appear to be associated with obstetric, psychological, and sociodemographic factors.
Fear of pain during childbirth can culminate in an overestimation of pain intensity and an underestimation of one's coping abilities. Additionally, by inducing tension, fear of pain intensifies the perception of pain and is associated with anxiety, distress, emotional processes, and disability. Women with severe fear of childbirth are at a high risk for impaired daily functioning and increased physical and psychological problems during pregnancy, during childbirth, and in the postpartum period.
In Golestan Province, the population is primarily divided into three main groups: Fars, Turkmen, and migrants, who are often Sistani/Baluch. The experience of fear of childbirth in women is influenced by various factors, such as ethnicity, culture, society, and environment. Given that diverse ethnicities, including Fars, Turkmen, and Sistani/Baluch, reside in Gorgan, and each mother from these ethnic groups may approach childbirth and childbearing differently depending on their culture, it is essential for healthcare providers to be aware of mothers' fear of childbirth. This insight is likely to help improve the quality of prenatal care. This study was conducted to determine the prevalence of fear of childbirth among pregnant mothers of various ethnicities referring to comprehensive health service centers in Gorgan, Iran.
Methods
This descriptive-analytical study was conducted on 341 pregnant women of Fars, Turkmen, and Sistani/Baluch ethnicities at comprehensive health service centers in Gorgan during 2023.
Using a non-probability sampling method, 341 pregnant mothers were selected from the household electronic record database system [Health Information Software (NAB)]. For data collection, a questionnaire was created on Google Forms (https://forms.gle/DT7JXuDMMSQQWPMb7). The researcher then visited comprehensive health service centers and, after obtaining the necessary information about pregnant mothers, invited them to participate in the study via text messages. Mothers who wished to attend the comprehensive health service centers completed the questionnaire in person. For mothers who preferred to complete the questionnaire at home, the questionnaire link was sent to them if they had a smartphone.
The data collection instruments consisted of a demographic characteristics form (age, education level, employment status, housing type, and ethnicity) and a pregnancy characteristics form (gravidity, pregnancy trimester, history of miscarriage, and maternal satisfaction with care received).
Another instrument used for data collection was the Childbirth Fear Questionnaire (CFQ; Zar and Wijma), 1988). This questionnaire consists of 33 items with six-point Likert scale responses, ranging from "completely" (0) to "not at all" (5). The minimum possible score is 0, and the maximum is 165. A score of 37 or less is classified as mild fear, 38 to 65 as moderate fear, and 66 to 84 as severe fear. The cutoff score for this questionnaire is 85, with scores of 85 and higher indicating clinical fear. Clinical fear is defined as an intense and pathological dread, known in psychology as phobia. Phobia involves an irrational and persistent fear that is disproportionate to any actual danger and significantly interferes with daily life. Items 2, 3, 6, 7, 8, 11, 12, 15, 19, 20, 24, 25, 27, and 31 are reverse-scored.
Results
Among all studied groups, mild fear (21 individuals), moderate fear (100 individuals), severe fear (147 individuals), and clinical fear (73 individuals) were identified in 6.2%, 29.3%, 43.1%, and 21.4% of the pregnant women, respectively. The highest prevalence of moderate fear of childbirth was observed in the Fars ethnicity (37.9%), while severe fear was most prevalent in the Turkmen (52.5%) and Sistani/Baluch (47%) ethnicities. Clinical fear was identified in 26% of the Sistani/Baluch ethnicity, 20.8% of the Turkmen ethnicity, and 18.6% of the Fars ethnicity. The combined prevalence of severe and clinical fear of childbirth was 73% in pregnant women of Sistani/Baluch ethnicity, 73.3% in pregnant women of Turkmen ethnicity, and 52.2% in pregnant women of Fars ethnicity. This difference was statistically significant (P < 0.004).
The variables of housing type (P < 0.03), pregnancy trimester (P < 0.001), and maternal satisfaction with care received at comprehensive health service centers (P < 0.008) exhibited a statistically significant association with fear of childbirth. The variables of education level, employment sstatus, gravidity, or history of miscarriage exhibited no statistically significant association with fear of childbirth. A significant association was observed between fear of childbirth and housing type (P < 0.03). Mothers residing in rental housing reported the highest levels of severe fear, while mothers in personal housing reported the highest levels of mild fear of childbirth. The highest level of fear of childbirth was noted in mothers in the third trimester of pregnancy, which was statistically significant (P < 0.001). A statistically significant relationship was also found between fear of childbirth and maternal satisfaction with care received at comprehensive health service centers (P < 0.008). The highest percentage of clinical fear of childbirth belonged to mothers who reported low maternal satisfaction with care received at these centers. Fear of childbirth had no statistically significant association with the variables of education level, employment status, gravidity, or history of miscarriage.
Conclusion
The present study's findings demonstrate that the fear of childbirth was moderate among women of Fars ethnicity, while it was severe among Turkmen and Sistani/Baluch ethnicities. Clinical fear of childbirth was higher among women of Sistani/Baluch ethnicity compared to women of Turkmen and Fars ethnicities. Collectively, severe fear and clinical fear were significantly higher among pregnant women of Sistani/Baluch and Turkmen ethnicities than among Fars women. Furthermore, variables related to the pregnancy period and maternal satisfaction with care received at comprehensive health service centers exhibited a significant association with fear of childbirth.
In the present study, a significant association was found between ethnicity and fear of childbirth, with varying levels of fear observed across the three ethnic groups studied. The highest prevalence of moderate fear of childbirth was noted among pregnant women of Fars ethnicity, while severe fear was more prevalent among Turkmen and Sistani/Baluch ethnicities. Clinical fear was most frequently identified within the Sistani/Baluch ethnic group compared to the Turkmen and Fars groups.
Iran is a multi-ethnic country, and Golestan Province, in particular, is home to a diverse population including Fars, Turk, Kurd, Turkmen, Baluch, Kazakh, and Sistani ethnicities, as well as a range of immigrants. Individuals report varying levels of fear of childbirth depending on their ethnic and cultural teachings. Therefore, considering ethnic differences is crucial when providing healthcare and support services to pregnant mothers.
In the present study, a significant correlation was observed between the variable of pregnancy trimester and fear of childbirth. Mothers in their third trimester of pregnancy reported higher levels of fear of childbirth, indicating that as pregnant mothers approach childbirth, their fear of childbirth increases. In the current study, a significant correlation was also found between the variable of maternal satisfaction with care received at comprehensive health service centers and fear of childbirth. Mothers who expressed greater satisfaction with care received and staff behaviors at comprehensive health service centers reported less fear of childbirth. Furthermore, a significant correlation was identified between the variable of housing type and fear of childbirth. Fear of childbirth is a subjective concept, influenced by each individual's personal experiences and perceptions. One of the limitations of this study is the subjective nature of the concept of fear of childbirth.
Given the ample opportunities for contact with pregnant women through prenatal care services at comprehensive health service centers, family health professionals and midwives working in these centers should be knowledgeable about fear of childbirth and take the necessary measures to ensure that pregnant mothers receive adequate education and counseling to alleviate this fear.
It is suggested that future studies on fear of childbirth investigate the variable of maternal ethnicity more extensively.
Ethical Statement
The study received approval from the Research Ethics Committee at Golestan University of Medical Sciences (IR.GOUMS.REC.1402.316).
Funding
This article has been extracted from a research project (No. 113794), approved by the Student Research and Technology Committee at Golestan University of Medical Sciences. This study received no institutional funding.
Authors' Contributions
Fahimeh Tajari: Project execution, data collection, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Saba Poolaie: Project execution, data collection, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Fatemeh Mehravar: Data analysis, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Akram Sanagoo: Project administration and design, project execution, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Leila Jouybari: Data analysis, interpretation of the results, drafting of the initial manuscript, and approval of the final manuscript.
Conflicts of Interest
No conflicts of interest.
Acknowledgments
We would like to thank the mothers and officials of the comprehensive health service centers in Gorgan who assisted us in implementing this project.
Key Message: The prevalence of severe and clinical fear of childbirth is higher among pregnant women of Sistani/Baluch and Turkmen ethnicities compared to those of Fars ethnicity.
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Tajari F, Poolaie S, Mehravar F, Sanagoo A, Jouybari L. Fear of Childbirth among Pregnant Women of Various Ethnicities Referring to Comprehensive Health Service Centers in Gorgan, Iran (2023). J Gorgan Univ Med Sci 2025; 27 (2) :83-92 URL: http://goums.ac.ir/journal/article-1-4522-en.html
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