Evaluating Family Bundle Birthing Care to Improve Self-Efficacy and Reduce Maternal Anxiety During Pregnancy
Abstract
Introduction: Pregnancy-related anxiety can affect both the experience and length of labor. Self-efficacy, defined as an individual’s belief in their ability to perform the behaviors required to achieve desired outcomes, plays a vital role in managing this anxiety. The Family Bundle Birthing Care (FBBC) approach, which actively involves the mother and her family especially the husband is believed to help lower anxiety levels and strengthen the pregnant woman’s self-efficacy. This study aims to assess the effect of the FBBC approach on reducing anxiety and enhancing self-efficacy among pregnant women.
Methods: A quasi-experimental design was employed with intervention and control groups, each consisting of 50 pregnant women. Data was collected using the childbirth education (W-DEQ-A), (W-DEQ-B), childbirth self-efficacy (CBSEI), and birth confidence (BCSQ) questionnaires to assess anxiety and self-efficacy. Data analysis was conducted using the fisher exact test and independent t-tests.
Results: The results indicated that the intervention group had significantly lower average scores on the W-DEQ-A and W-DEQ-B, and higher scores on the CBSEI and BCSQ questionnaires compared to the control group. The differences were statistically significant, with p-values of 0.001, 0.01, 0.02, and 0.01, respectively, suggesting that the family-based antenatal education program was effective in reducing anxiety and enhancing self-efficacy among pregnant women.
Conclusion: The FBBC program proved effective in reducing anxiety and enhancing self-efficacy in pregnant women. This approach could serve as an alternative method to improve mental preparedness and psychological support for expectant mothers as they approach labor.
References
Rúger-Navarrete A, Vázquez-Lara JM, Antúnez-Calvente I, Rodríguez-Díaz L, Riesco-González FJ, Palomo-Gómez R, et al. Antenatal Fear of Childbirth as a Risk Factor for a Bad Childbirth Experience. Healthcare (Switzerland). 2023 Feb 1;11(3). https://doi.org/10.3390/healthcare11030297
Bayrampour H, Ali E, McNeil DA, Benzies K, MacQueen G, Tough S. Pregnancy-related anxiety: A concept analysis. Vol. 55, International Journal of Nursing Studies. Elsevier Ltd; 2016. p. 115–30. https://doi.org/10.1016/j.ijnurstu.2015.10.023 PMID: 26626973
Fazdria, Harahap MS. Gambaran Tingkat Kecemasan Pada Ibu Hamil Dalam Menghadapi Persalinan Di Desa Tualang Teungoh Kecamatan Langsa Kota Kabupaten Kota Langsa Tahun 2014. JURNAL KEDOKTERAN SYIAH KUALA. 2016;16(1).
Striebich S, Mattern E, Ayerle GM. Support for pregnant women identified with fear of childbirth (FOC)/tokophobia – A systematic review of approaches and interventions. Midwifery. 2018 Jun 1;61:97–115. https://doi.org/10.1016/j.midw.2018.02.013 PMID: 29579696
Sun X, Fan X, Cong S, Wang R, Sha L, Xie H, et al. Psychological birth trauma: A concept analysis. Front Psychol. 2023 Jan 13;13. https://doi.org/10.3389/fpsyg.2022.1065612
Andersson L, Sundström-Poromaa I, Wulff M, Åström M, Bixo M. Implications of antenatal depression and anxiety for obstetric outcome. Vol. 104, Obstetrics and Gynecology. 2004. p. 467–76. https://doi.org/10.1097/01.AOG.0000135277.04565.e9 PMID: 15339755
Munkhondya BMJ, Munkhondya TE, Chirwa E, Wang H. Efficacy of companion-integrated childbirth preparation for childbirth fear, self-efficacy, and maternal support in primigravid women in Malawi. BMC Pregnancy Childbirth. 2020 Jan 21;20(1). https://doi.org/10.1186/s12884-019-2717-5 PMID: 31964346
Shanbhag S, Alva R. Early neonatal outcomes in premature rupture of membranes beyond twenty-eight weeks of gestation in a tertiary care hospital of coastal Karnataka. Journal of Pediatric Research. 2020;7(4):273–8. https://doi.org/10.4274/JPR.GALENOS.2019.75010
Zaman A, Fadlalmola HA, Ibrahem SE, Ismail FH, Abedelwahed HH, Ali AM, et al. The Role of Antenatal Education on Maternal Self-Efficacy, Fear of Childbirth, and Birth Outcomes: A Systematic Review and Meta-Analysis. Eur J Midwifery [Internet]. 2025 Mar 4;9(March). https://doi.org/10.18332/ejm/200747
Stoll K, Edmonds JK, Hall WA. Fear of Childbirth and Preference for Cesarean Delivery Among Young American Women Before Childbirth: A Survey Study. BIRTH. 2015;43(3).
Zarenejad M, Yazdkhasti M, Rahimzadeh M, Mehdizadeh Tourzani Z, Esmaelzadeh-Saeieh S. The effect of mindfulness-based stress reduction on maternal anxiety and self-efficacy: A randomized controlled trial. Brain Behav. 2020 Apr 1;10(4). https://doi.org/10.1002/brb3.1561 PMID: 32162450
Toohill J, Fenwick J, Gamble J, Creedy DK, Buist A, Turkstra E, et al. A Randomized Controlled Trial of a Psycho-Education Intervention by Midwives in Reducing Childbirth Fear in Pregnant Women. Vol. 41, BIRTH. 2014.
Waddington C, van Veenendaal NR, O’Brien K, Patel N. Family integrated care: Supporting parents as primary caregivers in the neonatal intensive care unit. Pediatr Investig. 2021 Jun 1;5(2):148–54. https://doi.org/10.1002/ped4.12277
Hu LQ, Lysandrou PJ, Minehart R, Wang JP, Xia Y, Hu Y, et al. Care Bundles: Enhanced Recovery after Delivery. Maternal-Fetal Medicine. 2023 Jul 1;5(3):155–62. https://doi.org/10.1097/FM9.0000000000000178
Serçeku? P, Ba?kale H. Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment. Midwifery. 2016 Mar 1;34:166–72. https://doi.org/10.1016/j.midw.2015.11.016 PMID: 26656473
Nystedt A, Hildingsson I. Women’s and men’s negative experience of child birth—A cross-sectional survey. Women and Birth. 2018 Apr 1;31(2):103–9. https://doi.org/10.1016/j.wombi.2017.07.002 PMID: 28789827
Massae AF, Larsson M, Leshabari S, Mbekenga C, Pembe AB, Svanberg AS. Fear of childbirth: validation of the Kiswahili version of Wijma delivery expectancy/experience questionnaire versions A and B in Tanzania. BMC Pregnancy Childbirth. 2022 Dec 1;22(1). https://doi.org/10.1186/s12884-022-05134-8 PMID: 36447188
Puspasari J, Nur Rachmawati I, Budiati T. Family support and maternal self-efficacy of adolescent mothers. Enferm Clin. 2018 Feb 1;28:227–31. https://doi.org/10.1016/S1130-8621(18)30073-1
Dai L, Shen Q, Redding SR, Ouyang YQ. Simulation-based childbirth education for Chinese primiparas: A pilot randomized controlled trial. Patient Educ Couns. 2021 Sep 1;104(9):2266–74. https://doi.org/10.1016/j.pec.2021.02.036 PMID: 33663905
Duncan LG, Cohn MA, Chao MT, Cook JG, Riccobono J, Bardacke N. Benefits of preparing for childbirth with mindfulness training: A randomized controlled trial with active comparison. BMC Pregnancy Childbirth. 2017 May 12;17(1). https://doi.org/10.1186/s12884-017-1319-3 PMID: 28499376
Gandomi N, Sharifzadeh G, Torshizi M, Norozi E. The effect of educational intervention based on self-efficacy theory on pregnancy anxiety and childbirth outcomes among Iranian primiparous women. J Educ Health Promot. 2022 Jan 1;11(1):14. https://doi.org/10.4103/jehp.jehp_1548_20
Kamsatun, Susanti S, Fattah VF, Februati S. Family Center Maternity Care (FCMC) is Effective in Reducing Anxiety in Pregnant Women . Jurnal Ilmu Dan Teknologi Kesehatan. 2023 Mar;10(2).
Wahyuni C. Efforts to Improve Postpartum Maternal Behavior through Family-Centered Maternity Care (FCMC) about Postpartum Care Education. Journal of Community Engagement in Health [Internet]. 2024 Sep 1;7(2):238–43. https://doi.org/10.30994/jceh.v7i2.626
Rahmayanti R, Oktafia R, Wahyuni F. Education Package Based On Family Centered Maternity Care To Increase Self Efficacy And Knowledge Of Breastfeeding Mothers in The Covid Pandemic. Med J Malaysia . 2023;78(4):530–3.
Kundarti FI, Kiswati, Komalyna INT. Mindfullness based intervention reduce anxiety in labor. Gac Sanit. 2024 Jan 1;38. https://doi.org/10.1016/j.gaceta.2024.102359 PMID: 38330537
Hawkins M, Misra D, Zhang L, Price M, Dailey R, Giurgescu C. Family involvement in pregnancy and psychological health among pregnant Black women. Arch Psychiatr Nurs. 2021 Feb 1;35(1):42–8. https://doi.org/10.1016/j.apnu.2020.09.012 PMID: 33593514
Lega I, Bramante A, Lauria L, Grussu P, Dubini V, Falcieri M, et al. The Psychological Impact of COVID-19 among Women Accessing Family Care Centers during Pregnancy and the Postnatal Period in Italy. Int J Environ Res Public Health. 2022 Feb 1;19(4). https://doi.org/10.3390/ijerph19041983 PMID: 35206171
Abera M, Hanlon C, Daniel B, Tesfaye M, Workicho A, Girma T, et al. Effects of relaxation interventions during pregnancy on maternal mental health, and pregnancy and newborn outcomes: A systematic review and meta-analysis. PLoS One. 2024 Jan 1;19(1 January). https://doi.org/10.1371/journal.pone.0278432 PMID: 38271440
Chauhan A, Potdar J. Maternal Mental Health During Pregnancy: A Critical Review. Cureus. 2022 Oct 25; https://doi.org/10.7759/cureus.30656
Satyanarayana VA, Lukose A, Srinivasan K. Maternal mental health in pregnancy and child behavior. Indian J Psychiatry. 2011 Oct;53(4):351–61. https://doi.org/10.4103/0019-5545.91911 PMID: 22303046
Cluxton-Keller F, Olson A. A Family-Based Collaborative Care Model for Treatment of Depressive and Anxiety Symptoms in Perinatal Women: Results From a Pilot Study. JMIR Pediatr Parent. 2023;6. https://doi.org/10.2196/45616
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