Document Type : Original Article
Authors
Abstract
BACKGROUND: Fear of childbirth is a common problem during pregnancy, which can give rise to
sleep disorders and diminish sleep quality. This study aimed to determine the effect of cognitive–
behavioral training on fear of childbirth and sleep quality of pregnant adolescent slum dwellers who
visited the slum health centers of Zahedan city, Iran, in 2020.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in 2020 on 100 pregnant
adolescent slum dwellers between 11 and 19 years old at 24–28 weeks pregnant. Multi‑stage sampling
was used and the participants were randomly divided into an intervention and a control group. The
intervention group received four sessions of cognitive–behavioral training at weekly intervals. The
control group only received routine care. The Wijma Delivery Expectancy/Experience Questionnaire
and the Pittsburgh Sleep Quality Index were filled before and 4 weeks after the training course.
The data were analyzed in SPSS 21 using independent t‑test, paired t‑test, Fisher’s exact test, and
Chi‑squared test. and covariance. A P value of < 0.05 was considered significant.
RESULTS: After the intervention, the fear of childbirth significantly decreased (P = 0.004), and sleep
quality significantly improved (P = 0.001) in the intervention group compared with the control group.
The results of analysis of covariance to control the significant effect of pre‑test scores showed that
the mean score of fear of childbirth (P = 0.03) and mean score of sleep quality (P = 0.001) in the
two groups after the intervention was statistically significant.
CONCLUSION: The results showed that in addition to reducing fear of childbirth, cognitive–behavioral
training improved the sleep quality of women in the intervention group. Therefore, this training could
be used as an easy and accessible method without complications to improve women’s health.
Keywords
- Dolatian M, Mirabzadeh A, Forouzan AS, Sajjadi H, Majd HA,
Moafi F, et al. Correlation between self‑esteem and perceived
stress in pregnancy and ways to coping with stress. Pajoohandeh
J 2013;18:148‑55.
2. Spice K, Jones SL, Hadjistavropoulos HD, Kowalyk K, Stewart SH.
Prenatal fear of childbirth and anxiety sensitivity. J Psychosom
Obstet Gynaecol 2009;30:168‑74.
3. Laursen M, Johansen C, Hedegaard M. Fear of childbirth and
risk for birth complications in nulliparous women in the Danish
national birth cohort. BJOG 2009;116:1350‑5.
4. Dewald JF, Meijer AM, Oort FJ, Kerkhof GA, Bögels SM. The
influence of sleep quality, sleep duration and sleepiness on school
performance in children and adolescents: A meta‑analytic review.
Sleep Med Rev 2010;14:179‑89.
5. Arasteh M, Yousefi F, Sharifi Z. Investigation of sleepquality and
its influencing factors in patients admittedto the gynecology and
general surgery of besathospital in sanandaj. Med J Mashhad Univ
Med Sci 2014;57:762-9. - 6. Jomeen J, Martin CR. The impact of choice of maternity care on
psychological health outcomes for women during pregnancy and
the postnatal period. J Eval Clin Pract 2008;14:391‑8.
7. Chang JJ, Pien GW, Duntley SP, Macones GA. Sleep deprivation
during pregnancy and maternal and fetal outcomes: Is there a
relationship? Sleep Med Rev 2010;14:107‑14.
8. Okun ML, LutherJF, Wisniewski SR, Wisner KL. Disturbed sleep
and inflammatory cytokines in depressed and nondepressed
pregnant women: An exploratory analysis of pregnancy
outcomes. Psychosom Med 2013;75:670‑81.
9. Alipour Z, Lamyian M, Hajizadeh E. Sleep quality in late
pregnancy and postpartum depression. Iran J Obstet Gynecol
Infertil 2012;14:39‑47.
10. Amiri P, Mirghafourvand M, Esmaeilpour K, Kamalifard M,
Ivanbagha RJ. The effect of distraction techniques on pain and
stress during labor: A randomized controlled clinical trial. BMC
Pregnancy Childbirth 2019;19:534.
11. Bouzari B, Fatahi A. Effect of behavioral group therapy on
childbirth fear and anxiety in pregnant women. MEJDS 2018;
8: 37–42.
12. Ghazaie M, Davoodi I, Neysi A, Mehrabizadeh Honarmand M,
Bassak Nejad S. The effectiveness of cognitive‑behavioral therapy
on fear of childbirth, fear of pain, self‑efficacy of childbirth and
tendency to caesarean in nulliparous women. Iran J Obstet
Gynecol Infertil 2016;19:1‑12.
13. Salmela‑Aro K, Read S, Rouhe H, Halmesmäki E, Toivanen RM,
Tokola MI, et al. Promoting positive motherhood among
nulliparous pregnant women with an intense fear of childbirth:
RCT intervention. J Health Psychol 2012;17:520‑34.
14. Vaiskarami HA, Adavi H, AzadbakhtZ, Amairian L. Effectiveness
of cognitive‑behavioral intervention training in decreasing the
students test anxiety and shyness. J Appl Psychol Res 2017;8:29‑45.
15. Khayat S, Dolatian M, Navidian A, Mahmoodi Z, Kasaeian A,
Fanaei H. Factors affecting adequacy of prenatal care in Suburban
women of Southeast Iran: A cross‑sectional study. J Clin
Diagnostic Res 2018;12:QC01‑5.
16. Khayat S, Dolatian M, Fanaei H, Navidian A, Mahmoodi
Z,Kasaeian A. Womens reproductive health status in Urbanslums
in Southeast Iran in 2017: A crosssectional study. J Midwifery
Reproductive Health 2020;8:206982.
17. Singh A, Gupta V, Agrawal D, Goyal P, Singh M, Lukhmana S.
A cross‑sectional study to investigate the impact of focused group
discussion on menstrual hygiene among rural school girls of
Southern Haryana, India. J Educ Health Promot 2020;9:260.
18. Saha I, Islam K, Paul B, Som T.Tobacco‑related morbidity and
nicotine dependence: An experience in an urban slum of Burdwan
district, West Bengal, India. J Educ Health Promot 2018;7:94.
19. Khayat S, Dolatian M, Navidian A, Kasaeian A, Mahmoodi Z.
Association between style of living and general health in
Suburban women: A cross‑sectional study in South East of Iran.
J Clin Diagn Res 2017;11:LC09‑13.
20. Stevens PE. Marginalized women’s access to health care:
A feminist narrative analysis. ANS Adv Nurs Sci 1993;16:39‑56.
21. Asadullah MN, Islam KMM, Wahhaj Z. Child marriage, climate
vulnerability and natural disasters in coastal Bangladesh. J Biosoc
Sci 2021;53:948‑67.
22. Anderson CA, Gill M. Childbirth related fears and psychological
birth trauma in younger and older age adolescents. Appl Nurs
Res 2014;27:242‑8.
23. Uçar T, Golbasi Z. Effect of an educational program based on
cognitive behavioral techniques on fear of childbirth and the birth
process. J Psychosom Obstet Gynaecol 2019;40:146‑55.
24. Wijma K, Wijma B, Zar M. Psychometric aspects of the W‑DEQ;
a new questionnaire for the measurement of fear of childbirth.
J Psychosom Obstet Gynecol 1998;19:84–97.
25. Mortazavi F. Validity and reliability of the Farsi version of
Wijma delivery expectancy questionnaire: An exploratory and
confirmatory factor analysis. Electron Physician 2017;9:4606‑15.
26. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The
Pittsburgh sleep quality index: A new instrument for psychiatric
practice and research. Psychiatry Res 1989;28:193‑213.
27. Heidari AR, Ehteshamzadeh P, Marashi M. The releationship
between insomnia intensity, sleep quality, sleepness and
mental health disorder with educational performance in female
adolescences of Ahvaz city. Woman Cult 2010;4:65–76.
28. Ghazaei M, Davodi I, Neysi A, Mehrabizadeh Honarmand M,
Basak Nejad S. Effectiveness of cognitive behavioral therapy and
psycho‑education on fear of natural childbirth and its related
variables. J Appl Psychol 2018;12:103‑25.
29. Ghasemi F, Bolbol‑Haghighi N, Mottaghi Z, Hosseini SR,
KhosraviA. The effect of group counseling with cognitivebehavioral
approach on self‑efficacy of pregnantwomen’s choice of vaginal
delivery. Iran J Psychiatry Behav Sci 2018;12:e7632.
30. Nieminen K, Malmquist A, Wijma B, Ryding EL, Andersson G,
Wijma K. Nulliparous pregnant women’s narratives of imminent
childbirth before and after internet-based cognitive behavioural
therapy for severe fear of childbirth: A qualitative study. BJOG
2015;122:1259‑65.
31. Aguilera-Martín Á, Gálvez-Lara M, Blanco-Ruiz M,
García-Torres F. Psychological, educational, and alternative
interventions for reducing fear of childbirth in pregnant women:
A systematic review. J Clin Psychol 2021;77:525‑55.
32. Khatibi S. [The effect of cognitivebehavioral counseling
onsleep quality of pregnant women. Zanjan (Persian)].
[Doctoraldissertation] Zanjan: Zanjan University of Medical
Sciences and Health Services; 2020. p. 1.
33. Kalmbach DA, Cheng P, O’Brien LM, Swanson LM, Sangha R,
Sen S, et al. A randomized controlled trial of digital cognitive
behavioral therapy for insomnia in pregnant women. Sleep Med
2020;72:82‑92.
34. Liu Y‑H, Lee CS, Yu C‑H, Chen C‑H. Effects of music listening
on stress, anxiety, and sleep quality for sleep‑disturbed pregnant
women. Women Health 2016;56:296‑311.
35. Montazeri M, Mirghafourvand M, Esmaeilpour K,
Mohammad‑Alizadeh‑Charandabi S, Amiri P. Effects of journal
therapy counseling with anxious pregnant women on their
infants’ sleep quality: A randomized controlled clinical trial. BMC
Pediatr 2020;20:229.
36. Zare H, Shaghaghi F, Dalir M. The effect of writing disclosure
on severity of symptoms of OCD and depression of individuals
with obsessive‑compulsive disorder. J. Clin. Psychol. 2012; 3 (4):
27‑34.
37. Maliszewska K, Świątkowska‑Freund M, Bidzan M, Preis K.
Relationship, social support, and personality as psychosocial
determinants of the risk for postpartum blues. Ginekol Pol
2016;87:442‑7.
38. Alipour Z, Lamyian M, Hajizadeh E. Fear of childbirth, trait
anxiety and quality sleep in pregnancy and birth outcomes in
nulliparous woman. Iran J Obstet Gynecol Infertil 2012;15:21‑30.