The effect of an mHealth application based on continuous support and education on fear of childbirth, self-efficacy, and birth mode in primiparous women: A randomized controlled trial

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Abstract

Background

The Fear of Childbirth (FOC) is associated with several adverse health outcomes for children and women. This study aimed to evaluate the effectiveness of an interactive mobile health application named Tele-midwifery with an emphasis on continuous care and education, on FOC, self-efficacy, and childbirth mode in primiparous women.

Methods

Seventy primiparous women attending the prenatal clinic of Baharlou Hospital in Tehran, Iran, were randomly assigned to two parallel intervention and control groups with 35 participants each. Women in the intervention group received Tele-midwifery for eight weeks, whereas women in the control group only received routine care. The Wijma delivery expectancy/experience questionnaire and the Childbirth Self-Efficacy Inventory were used to measure the FOC and self-efficacy at baseline and eight weeks after the intervention. The FOC and birth mode were also measured after birth.

Results

There was a significant decrease in FOC among women in the intervention group compared to control groups after eight weeks of intervention (- 20.9 [95% Confidence Interval,—24.01 to—17.83], p < 0.001), and after birth (- 30.8, [95% CI—33.8 to—27.97], p < 0.001). After eight weeks, the mean self-efficacy score in the intervention group was significantly higher than the control group (p < 0.001). Compared to the control group, the intervention group had a lower C-Section (CS) rate (p = 0.03).

Conclusions

Tele-midwifery intervention reduced FOC, increased women’s self-efficacy in childbirth, and decreased the number of CS in a group of first-time mothers. Healthcare providers can use the mHealth approach to support pregnant women with FOC.

Trial registration

Registration number: IRCT20200122046227N1, Registered on 27 January 2020.

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Most cited references 49

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Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Timothy Roberton, Emily Carter, Victoria Chou … (2020)

Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.

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Short-term and long-term effects of caesarean section on the health of women and children

Jane Sandall, Rachel Tribe, Lisa Avery … (2018)

The Lancet, 392(10155), 1349-1357

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Midwife-led continuity models versus other models of care for childbearing women.

Jane Sandall, Hora Soltani, Simon Gates … (2016)

Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care.

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Author and article information

Contributors

Sahar Khademioore:

ORCID: https://orcid.org/0000-0002-3025-0006

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Elham Ebrahimi: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Ahmad Khosravi: Role: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Shohreh Movahedi: Role: ConceptualizationRole: Project administrationRole: SupervisionRole: Writing – review & editing

Hector Lamadrid-Figueroa: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLOS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 1 November 2023

Publication date Collection: 2023

Volume: 18

Issue: 11

Electronic Location Identifier: e0293815

Affiliations

[1 ] Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

[2 ] Department of Epidemiology, Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran

[3 ] Department of Obstetrics and Gynecology Tehran University of Medical Sciences, Tehran, Iran

Instituto Nacional de Salud Publica, MEXICO

Author notes

Competing Interests: The authors have declared that no competing interests exist.

[¤]

Current address: Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada

* E-mail: khades1@ 123456mcmaster.ca

Author information

Sahar Khademioore https://orcid.org/0000-0002-3025-0006

Article

Publisher ID: PONE-D-23-17998

DOI: 10.1371/journal.pone.0293815

PMC ID: 10619799

PubMed ID: 37910495

SO-VID: 7790d026-6642-49c9-b336-743c97d625f8

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 14 June 2023

Date accepted : 9 October 2023

Page count

Figures: 2, Tables: 4, Pages: 15

Funding

The authors received no specific funding for this work.

Custom metadata

Data Availability The authors confirm all the data collected in this study has been thoroughly presented within the paper. However, this study was conducted in a single center over a short period of time, so making the data set public may lead to participant identification. Data set will be available upon request from the ethics committee of Tehran University of Medical Sciences at Ethics@ 123456sina.tums.ac.ir .

The effect of an mHealth application based on continuous support and education on fear of childbirth, self-efficacy, and birth mode in primiparous women: A randomized controlled trial

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Most cited references 49

Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Short-term and long-term effects of caesarean section on the health of women and children

Midwife-led continuity models versus other models of care for childbearing women.

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