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:: Volume 1, Issue 1 (6-2023) ::
Knowledge of Nursing 2023, 1(1): 10-25 Back to browse issues page
Anxiety at the Onset of Active Phase of Labor and some of its Predictors in Iranian Women
Sakineh Mohammad-Alizadeh-Charandabi , Jila Nahaee * , Fatemeh Abbas-Alizadeh , Mojgan Mirghafourvand
Department of Midwifery, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran , jnahaee@yahoo.com
Abstract:   (497 Views)
Abstract
Background and Aim: Severe anxiety during labor can result in adverse maternal and neonatal outcomes. Due to limited studies in Iran and other countries, this study aimed to assess the prevalence of women’s anxiety at the onset of active phase of labor and some of its predictors.
Materials and Methods: In this cross-sectional study, the participants included 700 low-risk singleton pregnant women with gestational age of 370-416, hospitalized for vaginal delivery at two teaching hospitals in Tabriz, Iran. The anxiety state [by using the Spielberger’s State Anxiety Inventory (SAI)] and dehydration were assessed at cervical dilatation of 4-6 cm. Variables correlated with the anxiety score with P<0.2 in the unadjusted analysis were included in the multiple linear regression model to determine the predictors.  
Results: The mean of the anxiety score was 49.3 (SD 11.7) out of the attainable score of 20-80. About two-thirds of the women had severe (39.6%) or moderate (26.6%) anxiety. The predictors of high anxiety score were: high fear (β=0.610), labor induction (β=0.196), dehydration ≥ 3 h (β=0.109) and < 3 h (β=0.073), second-hand smoke during pregnancy (β=0.087), and no attendance at childbirth preparation classes (β=0.054). The proportion of variance by all these factors was 62%.
Conclusion: Anxiety was very common intrapartum. The during-labor factors including high fear, labor induction, and dehydration were important predictors of the women’s anxiety. It seems that providing the women with appropriate counselling services during pregnancy and responding to their needs during labor could play a significant role in decreasing their anxiety.

 
Keywords: Anxiety, Prevalence, Labor, Iran.
Full-Text [PDF 412 kb]   (423 Downloads)    
Type of Study: Research | Subject: Special
Received: 2023/04/30 | Accepted: 2023/04/30 | Published: 2023/04/30
References
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3. Zijlmans MAC, Beijers R, Riksen-Walraven MJ, de Weerth C: Maternal late pregnancy anxiety and stress is associated with children's health: a longitudinal study. Stress 2017 Oct; 20(5):495-504. [DOI:10.1080/10253890.2017.1348497]
4. World Health Organization. Improving maternal mental health. 2008. Available from:https://www.who.int/mental_health/prevention/suicide/Perinatal_depression_mmh_final.pdf.
5. Al Gahtani AH, Al Khedair K, Al Jeheiman R, Al Turki HA, Al Qahtani NH. Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors. Int J Womens Health. 2018 Feb; 10:101-8. [DOI:10.2147/IJWH.S153273]
6. Sadeghi N, Azizi Sh, Mollaeenejad M. Anxiety status at third trimester of pregnancy and related factors in Bandarabass hospital. Iran. J. Obstet. Gynecol. Infertil. 2014 Nov; 17(122):8-15. [Persian]
7. Effati-Daryani F, Mohammad-Alizadeh-Charandabi S, Zarei S, Mohammadi A, Mirghafourvand M. Depression, anxiety and stress in the various trimesters of pregnancy in women referring to Tabriz health centres, 2016. Int J Cult Ment Health. 2018 Feb; 1-9. [DOI:10.1080/17542863.2018.1438484]
8. Silva MMJ, Nogueira DA, Clapis MJ, Leite EPRC. Anxiety in pregnancy: prevalence and associated factors. Rev Esc Enferm USP. 2017 Apr; 51. [DOI:10.1590/s1980-220x2016048003253]
9. Soto-Balbuena C, Rodríguez MF, Escudero Gomis AI, Ferrer Barriendos JF, Le H-N, Pmb-Huca G. Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy. Psicothema. 2018 Aug; 30(3):257-63.
10. Walsh TC. Exploring the effect of hospital admission on contraction patterns and labour outcomes using women's perceptions of events. Midwifery. 2009 Jun; 25(3):242-52. [DOI:10.1016/j.midw.2007.03.009]
11. Mohammadierad R, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Fazil F. Effect of Saffron with or without date sugar on intensity of pain and anxiety during labour in primiparous females: a randomized, controlled trial. Iran Red Crescent Med J. 2018 Jun; 20(S1):e61289. [DOI:10.5812/ircmj.61289]
12. Akkoz Cevik S, Karaduman S: The effect of sacral massage on labor pain and anxiety: A randomized controlled trial. Jpn J Nurs Sci. 2020 Jan; 17(1):e12272. [DOI:10.1111/jjns.12272]
13. Marchesi C, Ampollini P, Paraggio C, Giaracuni G, Ossola P, De Panfilis CH, et al. Risk factors for panic disorder in pregnancy: a cohort study. J Affect Disord. 2014 Mar; 156:134-8. [DOI:10.1016/j.jad.2013.12.006]
14. Viswasam K, Eslick GD, Starcevic V. Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis. J Affect Disord. 2019 Aug; 255:27-40. [DOI:10.1016/j.jad.2019.05.016]
15. Fairbrother N, Young AH, Janssen P, Antony MM, Tucker E. Depression and anxiety during the perinatal period. BMC Psychiatry. 2015 Agu; 15:206. [DOI:10.1186/s12888-015-0526-6]
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18. Ali NS, Iqbal SA, Badar SA, Sana SM. Frequency and associated factors for anxiety and depression in pregnant women: a hospital-based cross-sectional study. Scientific World Journal. 2012 May; 2012:653098. [DOI:10.1100/2012/653098]
19. Akhlaghi F, Mokhber N, Shakeri MT, Shamsa F. Relation between depression, anxiety, self-esteem, marital satisfaction, demographical factor and maternal complications with fear of childbirth in nulliparous women. Journal of Fundamentals of Mental Health. 2012 Sep; 14(2):122-31. [Persian]
20. Nahaee J, Abbas-Alizadeh F, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S: Pre- and during- labour predictors of dystocia in active phase of labour: a case-control study. BMC Pregnancy Childbirth. 2020 Jul; 20(1):425. [DOI:10.1186/s12884-020-03113-5]
21. Nahaee J, Mohammad-Alizadeh-Charandabi S, Abbas-Alizadeh F, Martin CR, Hollins Martin CJ, Mirghafourvand M, et al: Pre- and during-labour predictors of low birth satisfaction among Iranian women: a prospective analytical study. BMC Pregnancy Childbirth 2020 Jul; 20(1):408. [DOI:10.1186/s12884-020-03105-5]
22. Spielberger CD: Test anxiety inventory: "test attitude inventory". Palo Alto, Calif: Consulting Psychologists Press; 1980.
23. Mahram B. Validation of Spielberger anxiety test in Mashhad [dissertation]. Tehran: University of Oloom Tarbiaty Tabatabaie; 1994. [Persian]
24. Conningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25th ed. New York: Mc Graw hill; 2018.
25. The American Cancer Society medical and editorial content team. Dehydration and Lack of Fluids 2015. Available from:https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fluids-and-dehydration.html.
26. CRW VanVoorhis, L. Morgan B. Understanding power and rules of thumb for determining sample sizes. Tutorials in Quantitative Methods for Psychology. 2007 Sep; 3(2):43-50. [DOI:10.20982/tqmp.03.2.p043]
27. Størksen HT, Eberhard-Gran M, Garthus-Niegel S, Eskild A. Fear of childbirth; The relation to anxiety and depression. Acta Obstet Gynecol Scand. 2011 Feb; 91(2):237-42. [DOI:10.1111/j.1600-0412.2011.01323.x]
28. Salacz P, Csukly G, Haller J, Valent S. Association between subjective feelings of distress, plasma cortisol, anxiety, and depression in pregnant women. Eur J Obstet Gynecol Reprod Biol. 2012 Dec; 165(2):225-30. [DOI:10.1016/j.ejogrb.2012.08.017]
29. Hoseininasab SD, Taghavi S, Ahmadian S. The effectiveness of prenatal education in decreasing the childbirth pain and anxiety. Med J Tabriz Uni Med Sciences. 2010 Mar; 31(4):24-30. [Persian]
30. Segal S, Csavoy AN, Datta S. The tocolytic effect of catecholamines in the gravid rat uterus. Eur J Obstet Gynecol Reprod Biol. 1998 Oct; 87(4):864-9. [DOI:10.1213/00000539-199810000-00022]
31. Pross N. Effects of dehydration on brain functioning: A Life-Span Perspective. Ann Nutr Metab. 2017 Jun; 70 (Suppl. 1):30-6. [DOI:10.1159/000463060]
32. Jacob L, Smith L, Jackson SE, Haro JM, Shin JI, Koyanagi A. Secondhand Smoking and depressive symptoms among in-school adolescents. Am J Prev Med. 2020 May; 58(5):613-21. [DOI:10.1016/j.amepre.2019.12.008]
33. Moylan S, Jacka FN, Pasco JA, Berk M. How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways. Brain Behav. 2013 May; 3(3):302-26. [DOI:10.1002/brb3.137]
34. Pirdadeh Beiranvand S, Behboodi Moghadam Z, Salsali M, Alavi Majd H, Birjandi M, Bostani Khalesi Z . Prevalence of fear of childbirth and its associated factors in primigravid women: A cross- sectional study. Shiraz E Med J. 2017 Oct;18(11):e61896. [DOI:10.5812/semj.61896]
35. O'Connell MA, Leahy-Warren P, Kenny LC, O'Neill SM, Khashan AS. The prevalence and risk factors of fear of childbirth among pregnant women: A cross-sectional study in Ireland. Acta Obstet Gynecol Scand. 2019 Aug; 98(8):1014-23. [DOI:10.1111/aogs.13599]
36. Afusat OB. Prevalence and associated factors of anxiety and depression among pregnant women. J Neurol Neurosurg. 2018 Sep; 9(2):555758. [DOI:10.19080/OAJNN.2018.09.555758]
37. References
38. Koelewijn JM, Sluijs AM, Vrijkotte TGM: Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study. BMJ open. 2017 May; 7(5):e013413-e013413. [DOI:10.1136/bmjopen-2016-013413]
39. Zijlmans MAC, Beijers R, Riksen-Walraven MJ, de Weerth C: Maternal late pregnancy anxiety and stress is associated with children's health: a longitudinal study. Stress 2017 Oct; 20(5):495-504. [DOI:10.1080/10253890.2017.1348497]
40. World Health Organization. Improving maternal mental health. 2008. Available from:https://www.who.int/mental_health/prevention/suicide/Perinatal_depression_mmh_final.pdf.
41. Al Gahtani AH, Al Khedair K, Al Jeheiman R, Al Turki HA, Al Qahtani NH. Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors. Int J Womens Health. 2018 Feb; 10:101-8. [DOI:10.2147/IJWH.S153273]
42. Sadeghi N, Azizi Sh, Mollaeenejad M. Anxiety status at third trimester of pregnancy and related factors in Bandarabass hospital. Iran. J. Obstet. Gynecol. Infertil. 2014 Nov; 17(122):8-15. [Persian]
43. Effati-Daryani F, Mohammad-Alizadeh-Charandabi S, Zarei S, Mohammadi A, Mirghafourvand M. Depression, anxiety and stress in the various trimesters of pregnancy in women referring to Tabriz health centres, 2016. Int J Cult Ment Health. 2018 Feb; 1-9. [DOI:10.1080/17542863.2018.1438484]
44. Silva MMJ, Nogueira DA, Clapis MJ, Leite EPRC. Anxiety in pregnancy: prevalence and associated factors. Rev Esc Enferm USP. 2017 Apr; 51. [DOI:10.1590/s1980-220x2016048003253]
45. Soto-Balbuena C, Rodríguez MF, Escudero Gomis AI, Ferrer Barriendos JF, Le H-N, Pmb-Huca G. Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy. Psicothema. 2018 Aug; 30(3):257-63.
46. Walsh TC. Exploring the effect of hospital admission on contraction patterns and labour outcomes using women's perceptions of events. Midwifery. 2009 Jun; 25(3):242-52. [DOI:10.1016/j.midw.2007.03.009]
47. Mohammadierad R, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Fazil F. Effect of Saffron with or without date sugar on intensity of pain and anxiety during labour in primiparous females: a randomized, controlled trial. Iran Red Crescent Med J. 2018 Jun; 20(S1):e61289. [DOI:10.5812/ircmj.61289]
48. Akkoz Cevik S, Karaduman S: The effect of sacral massage on labor pain and anxiety: A randomized controlled trial. Jpn J Nurs Sci. 2020 Jan; 17(1):e12272. [DOI:10.1111/jjns.12272]
49. Marchesi C, Ampollini P, Paraggio C, Giaracuni G, Ossola P, De Panfilis CH, et al. Risk factors for panic disorder in pregnancy: a cohort study. J Affect Disord. 2014 Mar; 156:134-8. [DOI:10.1016/j.jad.2013.12.006]
50. Viswasam K, Eslick GD, Starcevic V. Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis. J Affect Disord. 2019 Aug; 255:27-40. [DOI:10.1016/j.jad.2019.05.016]
51. Fairbrother N, Young AH, Janssen P, Antony MM, Tucker E. Depression and anxiety during the perinatal period. BMC Psychiatry. 2015 Agu; 15:206. [DOI:10.1186/s12888-015-0526-6]
52. Tumblin A, Simkin P. Pregnant women's perceptions of their nurse's role during labour and delivery. Birth. 2001 Mar; 28(1):52-6. [DOI:10.1046/j.1523-536x.2001.00052.x]
53. Giardinelli L, Innocenti A, Benni L, Stefanini MC, Lino G, Lunardi C, et al. Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health. 2012 Feb; 15(1):21-30. [DOI:10.1007/s00737-011-0249-8]
54. Ali NS, Iqbal SA, Badar SA, Sana SM. Frequency and associated factors for anxiety and depression in pregnant women: a hospital-based cross-sectional study. Scientific World Journal. 2012 May; 2012:653098. [DOI:10.1100/2012/653098]
55. Akhlaghi F, Mokhber N, Shakeri MT, Shamsa F. Relation between depression, anxiety, self-esteem, marital satisfaction, demographical factor and maternal complications with fear of childbirth in nulliparous women. Journal of Fundamentals of Mental Health. 2012 Sep; 14(2):122-31. [Persian]
56. Nahaee J, Abbas-Alizadeh F, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S: Pre- and during- labour predictors of dystocia in active phase of labour: a case-control study. BMC Pregnancy Childbirth. 2020 Jul; 20(1):425. [DOI:10.1186/s12884-020-03113-5]
57. Nahaee J, Mohammad-Alizadeh-Charandabi S, Abbas-Alizadeh F, Martin CR, Hollins Martin CJ, Mirghafourvand M, et al: Pre- and during-labour predictors of low birth satisfaction among Iranian women: a prospective analytical study. BMC Pregnancy Childbirth 2020 Jul; 20(1):408. [DOI:10.1186/s12884-020-03105-5]
58. Spielberger CD: Test anxiety inventory: "test attitude inventory". Palo Alto, Calif: Consulting Psychologists Press; 1980.
59. Mahram B. Validation of Spielberger anxiety test in Mashhad [dissertation]. Tehran: University of Oloom Tarbiaty Tabatabaie; 1994. [Persian]
60. Conningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25th ed. New York: Mc Graw hill; 2018.
61. The American Cancer Society medical and editorial content team. Dehydration and Lack of Fluids 2015. Available from:https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fluids-and-dehydration.html.
62. CRW VanVoorhis, L. Morgan B. Understanding power and rules of thumb for determining sample sizes. Tutorials in Quantitative Methods for Psychology. 2007 Sep; 3(2):43-50. [DOI:10.20982/tqmp.03.2.p043]
63. Størksen HT, Eberhard-Gran M, Garthus-Niegel S, Eskild A. Fear of childbirth; The relation to anxiety and depression. Acta Obstet Gynecol Scand. 2011 Feb; 91(2):237-42. [DOI:10.1111/j.1600-0412.2011.01323.x]
64. Salacz P, Csukly G, Haller J, Valent S. Association between subjective feelings of distress, plasma cortisol, anxiety, and depression in pregnant women. Eur J Obstet Gynecol Reprod Biol. 2012 Dec; 165(2):225-30. [DOI:10.1016/j.ejogrb.2012.08.017]
65. Hoseininasab SD, Taghavi S, Ahmadian S. The effectiveness of prenatal education in decreasing the childbirth pain and anxiety. Med J Tabriz Uni Med Sciences. 2010 Mar; 31(4):24-30. [Persian]
66. Segal S, Csavoy AN, Datta S. The tocolytic effect of catecholamines in the gravid rat uterus. Eur J Obstet Gynecol Reprod Biol. 1998 Oct; 87(4):864-9. [DOI:10.1213/00000539-199810000-00022]
67. Pross N. Effects of dehydration on brain functioning: A Life-Span Perspective. Ann Nutr Metab. 2017 Jun; 70 (Suppl. 1):30-6. [DOI:10.1159/000463060]
68. Jacob L, Smith L, Jackson SE, Haro JM, Shin JI, Koyanagi A. Secondhand Smoking and depressive symptoms among in-school adolescents. Am J Prev Med. 2020 May; 58(5):613-21. [DOI:10.1016/j.amepre.2019.12.008]
69. Moylan S, Jacka FN, Pasco JA, Berk M. How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways. Brain Behav. 2013 May; 3(3):302-26. [DOI:10.1002/brb3.137]
70. Pirdadeh Beiranvand S, Behboodi Moghadam Z, Salsali M, Alavi Majd H, Birjandi M, Bostani Khalesi Z . Prevalence of fear of childbirth and its associated factors in primigravid women: A cross- sectional study. Shiraz E Med J. 2017 Oct;18(11):e61896. [DOI:10.5812/semj.61896]
71. O'Connell MA, Leahy-Warren P, Kenny LC, O'Neill SM, Khashan AS. The prevalence and risk factors of fear of childbirth among pregnant women: A cross-sectional study in Ireland. Acta Obstet Gynecol Scand. 2019 Aug; 98(8):1014-23. [DOI:10.1111/aogs.13599]
72. Afusat OB. Prevalence and associated factors of anxiety and depression among pregnant women. J Neurol Neurosurg. 2018 Sep; 9(2):555758. [DOI:10.19080/OAJNN.2018.09.555758]
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Mohammad-Alizadeh-Charandabi S, Nahaee J, Abbas-Alizadeh F, Mirghafourvand M. Anxiety at the Onset of Active Phase of Labor and some of its Predictors in Iranian Women. Knowledge of Nursing 2023; 1 (1) :10-25
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