Document Type : Original Article

Authors

1 Department of Anesthesia and Surgical Technologists, School of Nursing and Midwifery, Shiraz University of Medical Sciences

2 Department of Midwifery, Maternal‑Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

BACKGROUND: Anxiety before and pain intensity after cesarean section is among the factors that
should be taken into consideration among the candidates for cesarean section. The present study
aimed to investigate the effect of familiarity with cesarean section and the operating room environment
on anxiety and pain intensity among the mothers undergoing cesarean section.
METHODS: This clinical trial was conducted on 80 women referred to the hospitals affiliated to
Shiraz University of Medical Sciences for cesarean section in 2018. The participants were randomly
divided into a control (n = 40) and an intervention group (n = 40). The intervention group took part
in four educational sessions, while the control group received the hospital’s routine care. The Beck
Anxiety Inventory was completed by the two groups before and after the intervention. The McGill Pain
Questionnaire was also filled out by the two groups in the ward after the cesarean section. After all,
the data were entered into the SPSS software, version 21, and were analyzed using independent
t‑test and ANCOVA.
RESULTS: The results showed no significant difference between the two groups regarding the
mean score of anxiety prior to the intervention. After the intervention, the mean score of anxiety
was 7.98 ± 3.77 in the intervention group and 19.70 ± 6.45 in the control group, and the difference
was statistically significant (P < 0.0001). Indeed, the mean intensity of pain was 43.98 ± 7.63 in the
intervention group and 57.75 ± 10.69 in the control group after the intervention, and the difference
was statistically significant (P < 0.017).
CONCLUSION: The patients’ familiarity with cesarean section and the operating room environment
caused a decline in the anxiety level prior to cesarean section as well as a decrease in the score
of pain after the operation. Hence, midwives and nurses have to play effective roles in decreasing
pregnant women’s anxiety and pain through identification of strategies for empowering them and
managing their worries.

Keywords

1. Moscariello M, Bol KA. Cesarean section deliveries and
inductions of labor in Colorado: An analysis of current trends and
demographics. Health Statistics Section, Colorado Department
2. Amini P, Mohammadi M, Omani‑Samani R, Almasi‑Hashiani A,
Maroufizadeh S. Factors associated with cesarean section in
Tehran, Iran using multilevel logistic regression model. Osong
Public Health Res Perspect 2018;9:86‑92.
3. Mylonas I, Friese K. Indications for and risks of elective cesarean
section. Dtsch Arztebl Int 2015;112:489‑95.
4. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe‑Leitz T,
Azad T, et al. Relationship between cesarean delivery rate and
maternal and neonatal mortality. JAMA 2015;314:2263‑70.
5. Solehati T, Rustina Y. Benson relaxation technique in reducing
pain intensity in women after cesarean section. Anesth Pain Med
2015;5:e22236.
6. Rafiei M, Ghare MS, Akbari M, Kiani F, Sayehmiri F, Sayehmiri K,
et al. Prevalence, causes, and complications of cesarean delivery
in Iran: A systematic review and meta‑analysis. Int J Reprod
Biomed (Yazd) 2018;16:221‑34.
7. Ali A, Altun D, Oguz BH, IlhanM, Demircan F, Koltka K.The effect
of preoperative anxiety on postoperative analgesia and anesthesia
recovery in patients undergoing laparascopic cholecystectomy.
J Anesth 2014;28:222‑7.
8. Field T. Prenatal anxiety effects: A review. Infant Behav Dev
2017;49:120‑8.
9. Drzymalski DM, Lumbreras-Marquez MI, Tsen LC, Camann WR,
Farber MK. The effect of patient-selected or preselected music on
anxiety during cesarean delivery: a randomized controlled trial
[published online ahead of print, 2019 Mar 27]. J Matern Fetal
Neonatal Med. 2019;1-7. doi:10.1080/14767058.2019.1594766.
10. Kalliyath AK, Korula SV, Mathew A, Abraham SP, Isac M. Effect
of preoperative education about spinal anesthesia on anxiety and
postoperative pain in parturients undergoing elective cesarean
section: A randomized controlled trial. J Obstet Anaesthesia Crit
Care 2019;9:14.
11. Gorkem U, Togrul C, Sahiner Y, Yazla E, Gungor T. Preoperative
anxiety may increase postcesarean delivery pain and analgesic
consumption. Minerva Anestesiol 2016;82:974‑80.
12. Simonelli MC, Doyle LT, Columbia M, Wells PD, Benson KV,
Lee CS. Effects of connective tissue massage on pain in
primiparous women after cesarean birth. J Obstet Gynecol
Neonatal Nurs 2018;47:591‑601.
13. Chuang MF, Tung HH, Clinciu DL, Huang JS, Iqbal U, Chang CJ,
et al. The effect of an integrated education model on anxiety
and uncertainty in patients undergoing cervical disc herniation
surgery. Comput Methods Programs Biomed 2016;133:17‑23.
14. Talaie A, Tofani H, Hojjat SK, Allahmadi ZJ. The Effect of patients
familiarization with the staff and the operating room environment
on the day before the operation of tubectomy on anxiety before
surgery. Q J Fundamentals Ment Health 2004;6:57‑61.
15. Beck AT, Epstein N, Brown G, Steer RA. An inventory for
measuring clinical anxiety: Psychometric properties. Journal of
Consulting and Clinical Psychology 1988;56:893‑7
16. Kaviani Hossein MA. Psychometric properties of beck anxiety
inventory in the age and sex classes of the Iranian population.
Med J Tehran Univer Med Sci 2008;66:136‑40.
17. Dworkin RH, Turk DC, Trudeau JJ, Benson C, Biondi DM,
Katz NP, et al. Validation of the Short‑form McGill Pain
Questionnaire‑2 (SF‑MPQ‑2) in acute low back pain. The journal
of pain 2015;16(4):357‑66.
18. Khosravi M, Sadighi S, Moradi S, Zendehdel K. Persian‑McGill
pain questionnaire; translation, adaptation and reliability
in cancer patients: A brief report. Tehran University Med J
2013;71:53‑8.
19. Lin H‑H, Chang Y‑C, Chou H‑H, Chang C‑P, Huang M‑Y, Liu
S‑J, et al. Effect of music interventions on anxiety during labor:
A systematic review and meta‑analysis of randomized controlled
trials. PeerJ 2019;7:e6945.
20. Glover V. Prenatal stress and its effects on the fetus and the child:
Possible underlying biological mechanisms. Adv Neurobiol
2015;10:269‑83.
21. Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects
of maternal depression, anxiety, and perceived stress during
pregnancy on preterm birth: A systematic review. Women Birth
2015;28:179‑93.
22. Ding XX, Wu YL, Xu SJ, Zhu RP, Jia XM, Zhang SF, et al.
Maternal anxiety during pregnancy and adverse birth outcomes:
A systematic review and meta‑analysis of prospective cohort
studies. J Affect Disord 2014;159:103‑10.
23. Dahhani HD, Nasirrani K, Banader K, Hoshani H. The effect
of patients identification on cardiac surgery on anxiety in
patient undergoing artery bypass graft surgery. Modern Care J
2013;10:257‑63.
24. Borges NdC, Pereira LV, Moura LAd, Silva TC, Pedroso CF.
Predictors for moderate to severe acute postoperative pain after
cesarean section. Pain Res Manag 2016;2016:5783817.
25. Jahangir Far M, Taebi M, Dolatian M. The effect of Cinnamon
on primary dysmenorrhea: A randomized, double‑blind clinical
trial. Complement Ther Clin Pract 2018;33:56‑60.
26. Akbarzadeh;, M; Vaziri, F; Farahmand, M; Masoudi, Z, et al.
The effect of warm compress bistage intervention on the rate of
episiotomy, perineal trauma, and postpartum pain intensity in
primiparous women with delayed valsalva maneuver referring
to the selected hospitals of Shiraz University of medical sciences
in 2012‑2013. Adv Skin Wound Care 2016;29:79‑84.
27. Magoga G, Saccone G, Al‑Kouatly HB, Dahlen G H, Thornton C,
AkbarzadehM, et al. Warm perineal compresses during the second
stage of labor for reducing perineal trauma: A meta‑analysis. Eur
J Obstet Gynecol Reprod Biol 2019;240:93‑8.
28. Yazdanpanahi Z, Ghaemmaghami M, Akbarzadeh M, Zare N,
Azisi A. Comparison of the effects of dry cupping and acupressure
at acupuncture point (BL23) on the women with postpartum low
back pain (PLBP) based on short form McGill pain questionnaires
in Iran: A randomized controlled trial. J Family Reprod Health
2017;11:82‑9.
29. Farahmand M, Khooshab E, Hasanzadeh F, Amooee S,
Akbarzadeh M. The effect of warm compress Bi‑stage on pain
strength in labor stages and after delivery. Int J Womens Health
Reprod Sci 2020;8:46‑52.
30. Akbarzadeh M, Mohagheghzadeh A, Zare N, Yazdanpanahi A,
Ghaemmaghami M. Comparison of the effect of dry cupping
therapy and acupressure at BL23 point on intensity of
postpartum perineal pain based on the short form of McGill pain
questionnaire. J Reprod Infertil 2016;17:39‑46.
31. Akbarzadeh M, Masoudi Z, Hadianfard MJ, Kasraeian M, Zare N.
Comparison of the effects of maternal supportive care and
acupressure (BL32 acupoint) on pregnant women’s pain intensity
and delivery outcome. J Pregnancy 2014;2014:129208.
32. Behbahani BM, Ansaripour L, Akbarzadeh M, Zare N,
Hadianfard MJ. Comparison of the effects of acupressure
and self‑care behaviors training on the intensity of primary
dysmenorrhea based on McGill pain questionnaire among Shiraz
University students. J Res Med Sci 2016;21:107.
33. Kalati M, Kashanian M, Jahdi F, Naseri M, Haghani H,
Sheikhansari N. Evening primrose oil and labour, is it effective?
A randomised clinical tria. J Obstet Gynaecol 2018;38:488‑92.