Literature Review about how pregnant women can cope with the fear of childbirth

Review purpose and objective

The main purpose of the review was to analyze the studies with interventions for coping with fear of childbirth among pregnant women, along with assessing conceptual foundations of these studies (Striebich, Mattern, & Ayerle, 2018). The objective of review was to inform about need and ways of caring for pregnant women, such that Fear of Child Birth (FOC) can be lowered.

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Publish Protocol       

This study did not follow any specific publish protocol.

Inclusion Criteria for the Review

The inclusion criteria of the review included; the studies with severe level of FOC whereby women requested cesarean section, the studies using Wijma Delivery Expectancy Questionnaire (w-DEQ-A) and have obtained around > 66 points on the scale, the studies that have measured the effects of intervention (regardless of research design) and the one published in English and German (Striebich, Mattern, & Ayerle, 2018).

What types of study were included?

The studies that have focused on interventions for relief of FOC were mainly included in the review. There were three RCTs (from Australia, Sweden and Finland), four cohort studies (one from Norway and three from Sweden), five case control studies (from Sweden) and three qualitative hermeneutic studies (two from Norway and one from Sweden).

Databases/searched engines used

The study has made reliance on searching the following databases; MEDLINE (Ovid), PubMed, LIVIVO, EMBASE, and CINAHL (Striebich, Mattern, & Ayerle, 2018).

Suitability of Search Terms

The search terms used in the study have effectively addressed the topic as it has helped in tracking the studies with fear of child birth. The most widely used for this fear is tokophobia, which has also been used in search term and thus enabled to reach the most relevant studies.

Search Limits Applied

The limits for the review have excluded the studies with non-pregnant women and fathers. Additionally, it excluded the studies that have examined stress and anxiety.

Does PRISM flowchart adequately describe?

The PRISMA flow chart only describes that how many articles were identified, screened, assessed and chosen for inclusion in the study. The basis of excluding the articles after screening was not clearly mentioned in the article.

Critical Appraisal Instruments used

The review has mentioned that specific appraisal tools were used for assessing the risk biases in methodology of research articles. Specifically, Newcastle-Ottawa Scale (NOS) ratings were used and Critical Appraisal Skills Program (CASP) was also used to assess the quality of methodology used in chosen papers. The utilization of NOS was conducted for case control studies and its suitability is justified by the notion that it is most widely used tool for appraising case control studies (Harder, 2014).  On the other hand, the CASP is suitable for randomized controlled trials (Munn et al. 2014), but in the review it was also used for hermeneutics studies, which is less effective.

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Adequacy of summarizing included studies

The systematic review has clearly provided details about the type of the study, such that it included three RCTs, four cohort studies, five case control studies and three qualitative hermeneutic studies. The population for these studies were pregnant women. In terms of location, studies were from; Australia, Sweden, Finland and Norway. The systematic review has also provided clear details about the control group and study group, along with number of participants and the ways through which they were chosen.

The details of interventions was also clearly mentioned which have included internet delivered cognitive behavioral therapy, psycho-educative group sessions with relaxation exercises, provision of evidence based information through phone calls, combination of psycho-education group therapy and cognitive behavioral therapy and counseling related to FOC during pregnancy. Each research article included in the review have used different modes of delivering the intervention and they were clearly detailed in the tabular form in the underlying systematic review paper.

Finally, the review has clearly highlighted all the outcomes and results of the studies and provided detailed discussion on these results, allowing the effective understanding about FOC and its controlled measures (Striebich, Mattern, & Ayerle, 2018).

Are excluded studies listed with reasons for their exclusion?

The review has only provided that 356 studies were excluded followed by screening exercise, while two were excluded after eligibility analysis of the articles. There was no detail mentioned about the excluded studies. Additionally no reasoning was provided for exclusion.

How was the data abstracted and synthesised?

The authors have carried out detailed analysis of the chosen research articles for abstracting and synthesizing the data. Different tables were used to provide details of; year of publication, location, population and participants, control and study groups, results of the interventions and outcomes. The systematic review also addressed any methodological biases in the studies chosen.

Is there an adequate critique of the studies reviewed, including a discussion of study limitations?

The review has provided adequate critique of the studies which are being chosen. For instance, the limitations and methodological biases are clearly mentioned which could have affected the results of the study (Striebich, Mattern, & Ayerle, 2018). For instance, it was mentioned that there were chances of performance bias in RCT studies and data in RCT studies was incompletely mentioned. Likewise, Cohort studies have not randomly chosen the participants and single arm evaluation has not allowed to clearly state cause effect relationship. These instances state that biases and limitations were clearly mentioned for the reviewed studies.

Were the levels of evidence reported in this systematic review? What is your assessment of the level of evidence included in this review?

The review has reported the level of evidence, by mainly providing the p-values and scores on W-DEQ-A and W-DEQ-B. The p-value is considered a significant level of evidence and it clearly helps in understanding the power of effect. The effectiveness of intervention can thus be clearly analyzed through this level of evidence. On the other hand, the utilization of Wijma’s questionnaire is common in interventions focused on pregnant women and thus score of this scale is also a good level of evidence for reporting the outcomes of interventions.

Knowledge transfer from Systematic Review

The information from this systematic review can be transferred to practical clinical settings, with an aim of lowering the fear of childbirth among women. For instance, women can be educated on the aspect that their own cognitions are likely to affect their behavior and thus they should adopt conviction that they can control their condition during child birth.  The practitioners can also be taught about the importance of trusting and friendly relationship between midwives and pregnant women, such that individual needs of women can be addressed and they can be provided counseling for lowering their fear of labor. Additionally, based on the outcomes of the review, practitioners can devise sessions of therapy in effective way to lower the rate of FOC and to lower the rate of on-request cesarean section. The women should be encouraged to attend these sessions on each visit to their doctor or midwife.

References

Harder, T. (2014). Some notes on critical appraisal of prevalence studies: comment on:” the development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence”. International journal of health policy and management, 3(5), 289.

Munn, Z., Moola, S., Riitano, D., & Lisy, K. (2014). The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. International journal of health policy and management, 3(3), 123.

Striebich, S., Mattern, E., & Ayerle, G. M. (2018). Support for pregnant women identified with fear of childbirth (FOC)/tokophobia – A systematic review of approaches and interventions. Midwifery, 61, 97-115. doi:10.1016/j.midw.2018.02.013