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

  1. 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.
  2. 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.