It is a cross-sectional quantitative study to investigate the utility of birthing fear screening in maternity practice. The research investigates the effects of psychosocial, demographic, and obstetric factors on the birth outcomes of women with varying levels of childbirth anxiety, as well as the benefits of screening women for severe or high levels of childbirth dread. The findings have substantial implications for maternity care in Australia. Jocelyn Toohill from Menzies Health Institute Queensland Griffith Institute
Debra K. Creedy from Menzies Health Institute Queensland and Griffith Institute
Jenny Gamble from Menzies Health Institute Queensland and Griffith Institute
Jennifer Fenwick From Gold Coast University Hospital
Year, title, journal (in APA style): Toohill, J., Creedy, D. K., Gamble, J., & Fenwick, J. (2015). A cross-sectional study to determine utility of childbirth fear screening in maternity practice – An Australian perspective.
Abstract: (informative?) The abstract is very informative. It clearly states about the background of the problem and outlines the focus of the paper. It clearly describes the methods used to carry out the study including data collection and analysis as well as the sample size and the target population. The abstract also contains a summary of the study findings that are precisely outlined. There is a logical conclusion indicating that the inferences are reached from the evidence.
Problem: (clearly stated? Logical route from theory to problem?) The cross-sectional study aims to determine the utility of childbirth fear screening in maternity practice. The problem is well highlighted and justified in the background section of the paper. There are statistics to confirm the existence of the problem.
Literature Review: (relevant? current? sufficient?) The literature review is well articulated. The focus has been on the most recent articles on the problem. The authors have explored the problem in different angles and different countries for a broad overview and understanding. The evidence provided is sufficient to explore the problem and bring out the gaps for research as well as justify it. The reports as well as the articles used to highlight the problem in the paper are relevant as they describe the broad aspect of the child birth fear in maternity practice. The paper also highlights some of the interventions used by mid-wives to eliminate the fear.
Research questions/ hypothesis: (understandable? defined? testable?) The paper is a report of a secondary analysis of data that was collected from selected women that were in their selected trimester of pregnancy in a randomized control trial on childbirth fear. The research questions are clearly stipulated to gather the required evidence. Besides, they can be easily tested depending on the findings gathered using the study tools.
Research design (e.g. RCT, cohort study, retrospective, prospective, appropriate to address aim etc.): The study us a randomized control trial through secondary analysis of data that was collected from women in their second trimester in childbirth fear. It was appropriate to examine the problem as it gave room for comparison of two groups that is the control and intervention to make evidence-based conclusions.
Setting and study population (attributes of participants, locality, etc.): The study population for the study were women recruited in their second trimester of pregnancy. The intervention included women with severe childbirth fear while the control were the ones with less fear. The paper is a report of secondary analysis. Women were categorized according to the levels of fear. The women invited for the BELIEF study were all screened for childbirth fear. The study recruited participants from three maternity hospitals in South East Queensland.
Recruitment / subgroup / sample sizes (stated? appropriate?):
The paper clearly states the sample of women recruited for the study as reported in the secondary analysis of data. 1410 women were recruited to the study. The sample is appropriate as the randomized control trail involved the controls and interventions. The recruitment was properly done to reflect the problem as the sample composed of women in the third trimester of the pregnancy that are nearly expecting babies
Data Collected: (intervention / variables / measures outlined):
The data was collected from women that were recruited in a randomized control trial during their second trimester of pregnancy Psychosocial, and demographic factors were compared for ascertaining the levels of fear. WDEQ scores were categorized as high fear and severe fear. All the women that were invited b to the study were screened for Childbirth fear using the Antenatal Wijma Delivery Expectancy Questionnaire
Analysis of data: (clear how it was undertaken? tests seem relevant/ appropriate?)
The results of the study and the conclusion show that the analysis of the data that was conducted focused on the variables investigated and all the components of the study. The analysis of the questionnaires that were filled by the respondents captured all the variables investigated thus relevant and appropriate to the study. The researchers performed frequencies on all the variables.
Ethical issues: (ethical approval stated? Potential or specific ethical issues addressed?)
The ethical approval is clearly stated in the methods. However, the paper only states the place where ethical approval was sought without describing the specifics.
Results: (clear tables, level of significance?):
Results are clearly outlined with the measures of association explained with descriptions and tables. They reflect the issues that were being investigated and their effects in relation to the problem.
Discussion: (hypothesis accepted/ rejected? Were the results appropriately contextualized with other relevant evidence, Limitation discussed?):
The discussion comprised of the exploration of the findings of the study. The authors focused on the evidence generated from the study as well as vividly outlining the limitations. There is relevant discussion of further evidence related to the problem.
Conclusions (Implications for further research, Conclusions of authors supported by the data?) The conclusion by the authors is supported by the evidence from the study thus logical. Besides, there is a highlight of the implications for further research
Your overall assessment of the paper (brief summary statement of the clinical relevance of the paper based on your critique). The relevance of the paper is indicated by the recommendations made from the findings that are relevant in the broad maternity practice
Assessment item 1 TEMPLATE B:
Appraisal of a QUALITATIVE research paper
DESCRIPTION(dot points are appropriate) the paper describes the women’s fear of experiences of childbirth. It is a qualitative stud using phenomenological approach.
Authors: (and background): Christina Nillsson from Hogskolan I Boras
Ingela Lundgren from the University of Gothenburg.
Year, title, journal (in APA style):
(2007). Women’s lived experience of fear of childbirth. Midwifery, 25(2
Abstract: (informative?) the abstract is very informative with all the components. It has the background, methods, findings and conclusion.
Problem: (clearly stated? Logical route from theory to problem?) The problem is stated from a logical point of view. It is further justified by literature.
Literature Review: (relevant? current? sufficient?) The review of literature is relevant and sufficient for the justification of the studied problem. Current articles have been used to address the issues related to the problem and identify the gaps for further exploration.
Research aim: (clearly stated? Addresses gap?)
The research aim is clearly stated and addresses the gaps. The aim is answered by the findings.
Research design (what type of research method? matches aims?)
Research design the research is qualitative study that uses phenomenological approach as well as lifeworld perspective. It matches the aims of the study and the problem investigated.
Description study setting of participants (attributes, numbers, locality, etc.)
Data was collected in Sahlgrenska University,Gotenburg, Sweden. Eight pregnant women that were seeking help from an outpatient clinic with severe fear of childbirth were used.
Recruitment/ Selection/Sampling Method: (what was done? was it appropriate?) The women that were seeking help for severe fear of childbirth were recruited for the study. Sampling was done for the women seeking help for having severe fear of childbirth.
Method/s of data collection (e.g. interviews, observation, questionnaire, etc)
Data was collected using tape recorded interviews.
Method/s of data analysis (coding, thematic, clearly articulated?)
The recorded interviews were transcribed and classified according to the themes to highlight the issues covered in the study. Data was analyzed by using the descriptions by Dahlberg et al.
Trustworthiness (discussed?) the concept of trustworthiness is not highlighted in the paper.
Ethical issues addressed: (ethical approval stated? Potential or specific ethical issues addressed?) Ethical issues are indicated but not the specifics
Findings: (findings ‘ring true? use of participants words ‘fit’ with themes?)
The findings are categorized according to the themes to fulfill the objectives of the qualitative study. Four constituents were identified. Every theme is well covered.
Discussion: (Were the findings appropriately contextualized with other relevant evidence? Limitations discussed?) The discussion was an extension of the research findings as they were strengthened by evidence from other studies. The authors also reflected on the other areas that can be exploited in future. The limitations are also clearly outlined.
Conclusion: (Implications for further research? Conclusions supported by the data?)
The conclusion of the study is deduced from the findings and supported by the data.
Your overall assessment of the paper (brief summary statement of the clinical relevance of the paper based on your critique). The paper has implications for clinical practice as it outlines some of the ways in which midwives can assist women with the fear of childbirth and restoring trust.
The documents were obtained through online searches of various scientific databases including PubMed, Popline, Medline, and Cochrane Library to locate the materials relevant to the study topic of the childbirth fear in Australia. Google scholar search was also used to identify all the relevant materials directly related to the study topic. These were the peer-reviewed articles that met the inclusion criteria. The paper s that were published within 10 years were selected for the study.
The likelihood of identifying the relevant articles for the study was improved, the author customized the search engines to limit the duration as well as the study topic. Instead of using the broad topic, specific keywords were used for the search. Articles published between 2006-2017 were included in the customized search. Besides, the search was limited to the English language.
The inclusion criteria for the study was the qualitative and quantitative articles on different aspects of childbirth fear among women in Australia. Peer-reviewed articles were the only ones included in the study. Papers and conference abstracts, as well as duplicates, were excluded from the study. Besides, the relevant articles published below 2006 were not considered. Papers focusing on different aspects of childbirth and pregnancy without the concept of fear were considered irrelevant. Papers without a description of the study design used were not considered.
The search terms included keywords and phrases that could improve the likelihood of identifying the relevant articles. These included childbirth fear, attitudes, and beliefs of childbirth and pregnancy, attitudes, pregnancy maternity care, parity, caesarean section. To narrow the search, the phrases such as childbirth fear, factors increasing childbirth fear, attitudes and beliefs in childbirth fear were considered. The search was conducted using the identified search engines. The results of the irrelevant papers were discarded. The relevance of the identified articles was enhanced by regarding the abstract to ensure that the selection criteria are met. The irrelevant ones were excluded.
Requirement 3:
The selected that met the inclusion criteria are documented in the table below;
Author (year) Country
Study Design
Sample size
Comments/Key findings
Quality Appraisal
1.
Haines, H., Rubertsson, C., Pallant, J., & Hildingsson, I. (2012). The influence of women’s fear, attitudes and beliefs of childbirth on mode and experience of birth. BMC Pregnancy And Childbirth, 12(1). http://dx.doi.org/10.1186/1471-2393-12-55
Australia
Prospective longitudinal cohort design with self-report questionnaires that attitudinal statements on birth and the fear of birth scale
Pregnant women 18-20 weeks gestation 386 from Sweden and 123 from Australia
The study identified three clusters of women. The ones that were classified in the fearful cluster had an increased likelihood of negative birth effects. The odds of having an elective caesarean increased among the clusters of ‘fearful’ and ‘take it as it comes’ The ‘self-determiners had lower odds. The study revealed that the understanding of the attitudes of women as well as their levels of fear among the midwives is crucial as it tailors their interactions and consequently improving the maternity practice.
The article was included in the study
2.
Toohill, J., Fenwick, J., Gamble, J., & Creedy, D. (2014). Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy And Childbirth, 14(1). http://dx.doi.org/10.1186/1471-2393-14-275
Australia
A descriptive cross-sectional design was utilized for women in their second trimester of pregnancy. In three public hospitals, South East of Queensland.
The study recruited 1410 women in their second trimester of pregnancy in three public hospitals in Queensland.
The findings revealed that the overall prevalence of fear was 24% 31.5% nulliparous women reported high levels of fear as compared to multiparous women at 31.5% The childbirth fear was attributed to parity, mode of birth and paid employment. Childbirth fear was high among the women that had a previous operative birth and the first-time mothers. It was noted that normal birth acted as a protective factor to childbirth fear.
The article was reviewed and found relevant for the study.
3.
Byrne, J., Hauck, Y., Fisher, C., Bayes, S., & Schutze, R. (2013). Effectiveness of a Mindfulness-Based Childbirth Education Pilot Study on Maternal Self-Efficacy and Fear of Childbirth. Journal Of Midwifery & Women's Health, 59(2), 192-197. http://dx.doi.org/10.1111/jmwh.12075
Australia
A single-arm pilot study of the MBCE intervention that used repeated measures design for data analysis before and after intervention for the determinants of the key trends of the variables; anxiety, depression, stress and mindfulness
Pregnant women that are 18-28 weeks of gestation as well as their support companions that attended the 8 weeks of MBCE group sessions. 18 women were selected for the intervention
The pilot study revealed that skill-based and the mindfulness childbirth education intervention increased the women’s self-control as well as confidence in giving birth. The improvements in childbirth education significantly reduces the anxiety and fear among women because of their interactions with the midwives and other healthcare providers thus gaining confidence.
The article was found suitable to be included in the study.
4.
Hall, W., Hauck, Y., Carty, E., Hutton, E., Fenwick, J., & Stoll, K. (2009). Childbirth Fear, Anxiety, Fatigue, and Sleep Deprivation in Pregnant Women. Journal Of Obstetric, Gynecologic & Neonatal Nursing, 38(5), 567-576. http://dx.doi.org/10.1111/j.1552-6909.2009.01054.x
Canada
The study utilized a cross-sectional descriptive survey of a community sample to explore the level of childbirth fear, fatigue, anxiety and sleep deprivation.
The sample included 650 nulliparous and multiparous English-speaking women that were in 35-39 weeks of gestation and 17 to 46 years.
The results indicated that 25% of women indicated high levels of childbirth fear while 20.6% slept for less than 6 hours at night Anxiety, fatigue, childbirth fear and sleep deprivation were all positively correlated. The childbirth fear is triggered by the emotions and experiences of women. Most of these come from previous birth experiences.
The relevancy of the article made it to be included in the study.
Reason for the choice of the Articles
The choice of the papers was well informed. They were well connecting to the topic of study that is the childbirth fear among the pregnant women in Australia. Although papers addressed different contexts, they did not shift from the discussions. They developed the literature on the childbirth fear by addressing different aspects. Some focused on the prevalence and interventions for childbirth fears while the others clearly outlined the factors attributed to the childbirth fear. The papers helped the author understand the concept of childbirth fear in different dimensions and contribute to the literature to inform the broad maternity care.
Besides, the choice of the articles was informed by their structure under which the information could be deduced. The abstract of the papers selected for the analysis was clear thus offering the author an opportunity to view them before making a consideration. This way, he could easily identify the themes and the studies conducted to connect to the study topic and establish relation not to deviate. The papers were selected as they are relevant to the study topic and current thus containing the information that could inform the interventions to reduce the childbirth fear. They helped in exploring the current status of the problem among the pregnant women and identify the gaps in research that could be investigated further as well as make the necessary evidence-based recommendations to the maternity practice. The themes of the four papers was well connected and related to the other two that were provided. Some were qualitative while others were quantitative thus giving a mix of evidence that is required to explore the study topic. Besides, the credibility of the papers selected was proven by being peer-reviewed. Therefore, the evidence generated is ascertained.
Requirement 4
Summary of the Articles
The attitudes, as well as the fears among women during pregnancy, directly influences the maternity practice and care. Some of the obvious issues in childbirth fear are the anxiety of women and the uncertainties that they develop regarding their abilities to cope with labour and the entire process (Toohill, Creedy, Gamble & Fenwick, 2015). Their expectations shift throughout the intrapartum care.
Childbirth fear that comes with different sociological factors among women. These are dependent on several factors among them the sociodemographic variables, family, exposure and age (Hall et al., 2009). The process of childbirth should be associated with minimal risk concerning adverse outcomes to reduce the childbirth fear that is common among the first-time mothers (Nilsson & Lundgren, 2009). Bad experiences among women in previous births have been one of the reasons that many of them term the process as traumatic (Toohill, Fenwick, Gamble & Creedy, 2014).
Besides, the mishandling by the healthcare professionals make them fear the experience. Although there is no extensive research in Australia regarding childbirth fear, the studies confirm that the phenomena are attributed to obstetric and demographic factors (Byrne, Hauck, Fisher, Bayes & Schutze, 2013). Education, age as well as the level of education plays a significant role in triggering childbirth fear (Toohill, Fenwick, Gamble & Creedy, 2014). The uncertainties that are attributed to financial worries greatly contribute to childbirth fear especially among the women expecting their first babies. Besides, the unplanned obstetric interventions contribute to the phenomena (Haines, Rubertsson, Pallant & Hildingsson, 2012).
Lack of extensive exploration of the concept of childbirth fear provides an opportunity for further research in its prevalence as well as the obstetric characteristics and demographic variables attributed to the phenomena. Communication should be the tool used to raise the discussions about the personal impacts of pregnancy and childbirth and incorporate the aspects of safety in pregnancy (Toohill, Creedy, Gamble & Fenwick, 2015). Debunking the myths that are related to the fear of childbearing has been identified as one of the interventions to improve antenatal care.
The maternity practice should incorporate best practice measures to address the specific concerns of women before childbirth to alleviate their worries (Hall et al., 2009). Besides, the evidence from the articles indicates the need for the midwives to keep the births normal in the first pregnancies to alleviate all the associated fears (Toohill, Fenwick, Gamble & Creedy, 2014).
Besides, the findings reveal a gap for further investigation regarding the features that can be amenable to change. There is need to address the cross-cultural differences in antenatal care that could be some of the contributors to childbirth fear. The findings from the studies can be used to assist in the maternity practice regarding profiling women who are likely to experience secondary fear of childbirth. The focus of maternity health policy in Australia should, therefore, take into consideration the beliefs and attitude of women during their periods of childbearing to improve their care (Toohill, Creedy, Gamble & Fenwick, 2015). This covers their psychosocial well-being of the women in a patient-centred approach. The midwife should investigate how sharing information pregnant women and others impacts on their beliefs and attitudes regarding childbirth fear.
Understanding the extent of fearfulness of women concerning childbirth is therefore crucial to sensitively place them at the right maternity care. Staying with the women and working for women to have the first antenatal care visit after ten weeks and then accompanied by 7-10 antenatal visits. There are a variety of options in the antenatal care that involve the general practitioners (Toohill, Fenwick, Gamble & Creedy, 2014). The interactions serve as reassurance strategies. The anxiety and anticipation by the pregnant women can be transformed into a positive feeling of motherhood. It is necessary to reduce the traumatic experiences in delivery to deal with childbirth fear. The recommendations that were made from all the articles were as a result of an agreement between all the authors. The harmony in the suggestions was an indication of the agreement between them.
Pregnancy in Australia is commonly managed in general practice. It is considered as one of the safest countries in the world to give birth (Toohill, Fenwick, Gamble & Creedy, 2014). The Australian guidelines for antenatal care have recommendations. Obstetricians, midwives and the general practitioners give the pregnant women useful information to have a healthy pregnancy. The models of antenatal care that are effective in Australia focus on the individual needs of the women as well as their preferences. A woman -centred approach is emphasized antenatal care guidelines that ensure the spiritual, physical, psychological, emotional, social and cultural expectations of women are properly addressed (Toohill, Fenwick, Gamble & Creedy, 2014). They are given crucial information in appropriate forms. The discussion of the psychosocial issues in the antenatal visits is crucial to address the factors that might contribute to the childbirth fear.
The guidelines are informed by evidence-based recommendations to improve the aspects of care of the pregnant women. Therefore, the recommendations of the articles on the childbirth fear reflect what is already happening in maternity care in Australia. For instance, the aspect of handling the emotional, social and cultural aspects of women health are already addressed in the antenatal guidelines. Spending time with the pregnant women in the antenatal visits and sharing crucial information is one of the ways to debunk the cultural myths that may be attributed to the childbirth fear. Besides, the woman-centred approach to care addresses all aspects of their health this reducing uncertainties and anxiety (Haines, Rubertsson, Pallant & Hildingsson, 2012).
However, the adoption of such recommendations will require adequate preparations for the healthcare professionals to handle the women experiencing the problems. For instance, the midwives attending the pregnant women with high and severe childbirth fear should undergo additional training in psychology to be abler to handle their feelings, emotions as well as lift their spirits. This would have cost implications for gaining skills. The benefits associated with the adoption of the recommendations include the reduction in the prevalence of childbirth fear in Australia and improving the birth outcomes. Besides, the midwives will broaden their skills in antenatal care.
Requirement 5:
The best aspects of the assignment included the fact that the relevant articles that were searched for the study added to the existing knowledge. Besides, the search of the articles in different databases improved the author’s skills for the systematic literature review. The research population in the articles selected for the topic is similar to the people accessing maternity care in Australia. Although there may be variations in age, most of the articles addressed pregnant women without the age groups. These are the ones at the childbearing age and in need of the holistic care to address their health. Most of the issues tackled in the articles such as the factors contributing to childbirth fear are the ones present in real life situations affection the social and psychological well-being of women. For instance, anxiety and uncertainties in childbirth are some of the concerns that increase fear among women regarding child birth. Most of it is caused by lack of the right information or bad experiences in childbirth as well as healthcare institutions. The target population is crucial as it determines whether the recommendations should be adopted. In this case, the population is the same as the one seeking maternity care in Australia thus the recommendations should be adopted to improve the practice.
The topic of the study was very broad thus increasing the number of articles searched. It meant that one could find many articles provided there is a relationship with child fear. The improvements that can be made include making the topic specific to narrow the searches and become more focused.
The researcher would like a feedback on the quality of the study materials searched for evaluation of the skills.
References
Byrne, J., Hauck, Y., Fisher, C., Bayes, S., & Schutze, R. (2013). Effectiveness of a Mindfulness-Based Childbirth Education Pilot Study on Maternal Self-Efficacy and Fear of Childbirth. Journal Of Midwifery & Women's Health, 59(2), 192-197. http://dx.doi.org/10.1111/jmwh.12075
Haines, H., Rubertsson, C., Pallant, J., & Hildingsson, I. (2012). The influence of women’s fear, attitudes and beliefs of childbirth on mode and experience of birth. BMC Pregnancy And Childbirth, 12(1). http://dx.doi.org/10.1186/1471-2393-12-55
Hall, W., Hauck, Y., Carty, E., Hutton, E., Fenwick, J., & Stoll, K. (2009). Childbirth Fear, Anxiety, Fatigue, and Sleep Deprivation in Pregnant Women. Journal Of Obstetric, Gynecologic & Neonatal Nursing, 38(5), 567-576. http://dx.doi.org/10.1111/j.1552-6909.2009.01054.x
Nilsson, C., & Lundgren, I. (2009). Women's lived experience of fear of childbirth. Midwifery, 25(2), e1-e9. http://dx.doi.org/10.1016/j.midw.2007.01.017
Toohill, J., Creedy, D., Gamble, J., & Fenwick, J. (2015). A cross-sectional study to determine utility of childbirth fear screening in maternity practice – An Australian perspective. Women And Birth, 28(4), 310-316. http://dx.doi.org/10.1016/j.wombi.2015.05.002
Toohill, J., Fenwick, J., Gamble, J., & Creedy, D. (2014). Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy And Childbirth, 14(1). http://dx.doi.org/10.1186/1471-2393-14-275
