The lived experiences of pregnant women during COVID-19 pandemic: a descriptive phenomenological study.

BACKGROUND: With the onset of the COVID-19 epidemic, pregnancy and childbirth for women are taking place in unusual circumstances. We explored the lived experiences of pregnant women during the COVID-19 pandemic to better understand their experience of pregnancy so that better support could be provided. METHODS: We used a descriptive phenomenological approach to understand the lived experience of pregnant women in COVID-19 pandemic. We collected data using a purposive sampling method through in-depth interviews in cyberspace with a semi-structured questionnaire. We used Colaizzi's seven-step content analysis method to analyze the research data with the help of MAXQDA software version 2020. RESULTS: We conducted this descriptive phenomenology study on 19 pregnant women in a period between the 10th to the 20th of May, 2020. The participating women were already pregnant when the first signs of the epidemic appeared in the country and at the time of the interview. We acquired four themes including disruption of the tranquility and regular routines of daily life, new challenges caused by the epidemic, resilience and strength in facing the crisis, and adaptation with new conditions. CONCLUSIONS: The pregnant women were under intense stress during the COVID-19 outbreak. The general mobilization the health system is necessary for alleviating pregnant women's difficulties in situations like the COVID-19 epidemic. Virtual training classes and virtual counseling may enhance the peace and tranquility of pregnant women.

Predictors of fear of childbirth and normal vaginal birth among Iranian postpartum women: a cross-sectional study.

BACKGROUND: Fear of childbirth (FOC) may contribute to postpartum depression, impaired maternal-infant relation, and preference for cesarean in future pregnancies. We aimed to investigate predictors of FOC and normal vaginal birth among postpartum women who had planned for a normal vaginal birth. METHODS: This cross-sectional study was conducted in 2019 with postpartum women during the first 24 h after the birth. A sample of 662 women, selected using a convenient sampling method, filled out the questionnaire composed of socio-demographic and obstetric questions and the Wijma Delivery-Expectancy Questionnaire (W-DEQ). We used multiple logistic regression analyses to determine predictors of FOC and normal vaginal birth. RESULTS: The percentage of women with mild (score ≤ 37), moderate (38-65), high (66-84), severe (85-99), and intense FOC (score ≥ 100) were 7.9, 19.5, 40.9, 21.1, and 10.6% respectively. Predictors of intense FOC were age < 30, primiparity, low maternal satisfaction with pregnancy, and a low level of perceived marital satisfaction. Overall, 21.8% of women gave birth by cesarean. Predictors of normal vaginal birth were birth weight < 4 kg, spontaneous onset of labor pain, mother's age < 30, term pregnancy, having a doula, multiparity, satisfaction with husband's support, and overall satisfaction with pregnancy. A high level of perceived marital/sexual satisfaction was a risk factor for cesarean. Mode of birth was not a predictor of postpartum FOC. CONCLUSIONS: The rate of severe and intense FOC among this group of postpartum women is high. Our findings highlight modifiable factors for reducing FOC and increasing normal vaginal birth. In designing programs to increase the rate of normal vaginal birth, the following factors should be considered: limiting induced labor, encouraging women to recruit a doula to help them at labor, facilitate husband's attendance throughout antenatal/intrapartum, and postnatal care to support his wife, and pay attention to women's common misunderstandings about the effect of vaginal birth on marital/sexual relationship. Our findings indicate that seeking novel ways to promote marital/sexual satisfaction and helping women to have a smooth, hassle-free pregnancy may contribute to a reduction in the rate of the FOC.

Pregnant women's well-being and worry during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: COVID-19 caused some worries among pregnant women. Worries during pregnancy can affect women's well-being. We investigated worry and well-being and associated factors among pregnant women during the COVID-19 pandemic. METHODS: This descriptive cross-sectional study was conducted on 484 pregnant women using an online questionnaire. Sampling was performed in a period between May 5 and Aug 5, 2020. Inclusion criteria were having a single healthy fetus and having no significant psychological disorder. We collected the data using the Persian versions of the World Health Organization's Well-Being Index (WHO-5 Well-Being Index) and the Cambridge Worry Scale. We used univariate and multivariate logistic regression analyses to identify predictors of women's worry and well-being. RESULTS: The mean total scores of the WHO-5 Well-Being Index and the percentage of WHO-5 score < 50 were 64.9 ± 29.0 and 24.4%, respectively. Predictors of women's worry are the increased level of fear of COVID-19 (OR = 6.40, p <  0.001), a low family income (OR = 3.41, p <  0.001), employment status (OR = 1.86, p = 0.019), nulliparity (OR = 1.68, p = 0.024), having a COVID-19 infected person among relatives (OR = 2.45, p = 0.036), having a history of abortion (OR = 1.86, p = 0.012), having participated in the study after the first wave of COVID-19 outbreak (OR = 2.328, p = 0.003), and women's age < 30 year (OR = 2.11, p = 0.002). Predictors of low level of well-being in pregnant women are worry about their own health and relationships (OR = 1.789, p = .017), worry about fetus health (OR = 1.946, p = 0.009), and having at least one infected person with COVID-19 among relatives (OR = 2.135, p = 0.036). CONCLUSIONS: The percentage of women experiencing a low well-being state was relatively high. This result is worthy of attention by health care providers and policy makers. Providing care and support to pregnant women should have high priority during the COVID-19 pandemic.

Psychometric properties of the birth satisfaction scale-revised (BSS-R) in a sample of postpartum Iranian women.

Childbirth satisfaction may positively affect maternal intention to have a future pregnancy and preference to have a cesarean. We translate the UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) into Persian and validate an Iranian-BSS-R for future use in this population. In total, 784 mothers who were hospitalized in postpartum wards completed the Persian version of the BSS-R. The confirmatory factor analysis on 10-items scale confirmed the conventional three-factor structure. The Cronbach's alpha of the Iranian-BSS-R subscales and the total score were within the range of 0.53-0.76. Our findings provide further evidence that the BSS-R is an internationally reliable and valid instrument to measure birth satisfaction.

Association of exposure to air pollution and green space with ovarian reserve hormones levels.

Exposure to air pollution has been associated with adverse health effects while exposure to greenspace has been associated with public health benefits. However, the available evidence on the association of exposure to air pollution with ovarian reserve markers is still scarce, with no study on such an association with greenspace exposure. Therefore, this study aimed to investigate the association of exposure to particulate matter with diameter of less than 1, 2.5 and 10 µm (PM1, PM2.5, PM10), traffic indicators (distance from women's residence to major roads and total street length in different buffers around women's residential address) and greenspace indicators (residential surrounding greenspace and distance to green spaces) with serum levels of anti-müllerian hormone (AMH) and follicle stimulating hormone (FSH) as markers of ovarian reserve. This cross-sectional study was based on 67 women residing in Sabzevar, Iran (2018). Basal serum levels of FSH and AMH were measured by the enzyme-linked immunosorbent assays (ELISA). Land use regression models were used to estimate PMs concentrations at residential addresses and the average of normalized difference vegetation index (NDVI) in different buffers was used to characterize residential surrounding greenspace. Multiple linear regression models were developed to estimate the association of AMH and FSH with exposure to air pollution, traffic, and greenspace (one at a time) controlled for relevant covariates. In fully adjusted models, there was an inverse association between exposure to PM1, PM2.5 as well as total street length in 100 m buffer around women's residence and AMH level (ß = -0.89, 95% confidence interval (CI): -1.43, -0.35, P-value ≤ 0.01, ß = -1.11, 95% CI: -1.67, -0.55, P-value ≤ 0.01 and ß = -0.76, 95% CI: -1.48, -0.50, P-value = 0.03, respectively). Moreover, increase in distance from home to nearest major road as well as residential surrounding greenspace (100 m buffer) and decrease in residential distance to a green space larger than 5000 m2 were associated with increase in serum level of AMH. However, we did not observe any significant association between exposure to air pollution, traffic, and greenspace with FSH level. Overall, our findings supported a beneficial association of exposure to greenspace and detrimental association of exposure to air pollution with ovarian reserve.

A cross-sectional study of low birth satisfaction during the COVID-19 epidemics' fifth wave.

AIM: To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID-19 epidemics' fifth wave. DESIGN: A cross-sectional study. METHODS: This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction. RESULTS: The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC-19S (14.7 ± 7.5), WHO-5 (67.5 ± 13.0) and BSS-R (28.6 ± 7.3). Sixty-five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well-being score < 50, fear of COVID-19, low satisfaction with pregnancy and low satisfaction with spouse's support. The overall proportion of the variance in birth satisfaction explained by all variables is 17.4%. Labor and birth variables explained 12.2% of the variance in birth satisfaction. PATIENT OR PUBLIC CONTRIBUTION: None.

A structural equation model analysis of the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth: The mediating role of maternal fear of childbirth.

BACKGROUND: Pregnancy and childbirth may provoke various emotional responses in expectant fathers including excessive fear of childbirth. It is not unreasonable to assume that fear of contracting the virus during the COVID-19 pandemic, may have intensified fathers' fear of childbirth. This study aims to determine the mediating role of the expectant mothers' fear of childbirth in the relationship between expectant fathers' fear of COVID-19 and their fear of childbirth. METHODS: This cross-sectional study was conducted on 270 pregnant women and their spouses attending health centers from Aug 2021 to April 2022. Fathers' fear of childbirth scale (FFCS), Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A), and Fear of COVID-19 Scale (FCV-19S) were used to collect data. To examine the relationships between variables and to develop the final model, we used the structural equation model (SEM). RESULTS: The prevalence of severe fear of childbirth in fathers and their female spouses were 40.9% and 22.4%, respectively. The mean score and standard deviation of fear of childbirth in the fathers and their female spouses were 49.2 ± 17.1 and 62.5 ± 29.4, respectively. Results showed that fathers' fear of COVID-19 was directly (B = 0.44, p = 0.004) and indirectly (B = 0.13, p = 0.015) associated with fathers' fear of childbirth. Also, women's fear of childbirth was positively associated with fathers' fear of childbirth (B = 0.45, p = 0.030). In the final model, the values of χ2/df, CFI, PCFI, RMSEA, and SRMR were equal to 2.32, 0.94, 0.76, 0.07, and 0.06, respectively. CONCLUSIONS: We found a high prevalence of severe fear of childbirth in Iranian expectant fathers which means that fathers' fear of childbirth is a national health concern that needs to be addressed. The findings of the present study indicate that mothers' fear of childbirth has a mediating role in the relationship between fathers' fear of COVID and fear of childbirth. Therefore, to alleviate fathers' fear of childbirth, interventions to reduce fathers' fear of COVID-19 and women's fear of childbirth should be developed and implemented. The impact of fathers' mental health on the fear of childbirth in expectant couples should be further investigated.

Medical students' psychological and behavioral responses to the COVID-19 pandemic: A descriptive phenomenological study.

On February 19, 2020, the Iranian government officially confirmed the first deaths due to COVID-19 and within a week, all universities were closed. The purpose of this study is to explore Iranian medical students' psychological and behavioral responses to the COVID-19 pandemic. This descriptive phenomenological study was conducted on 52 medical students. Data were collected using a purposive sampling method by means of synchronous virtual focus group discussions which were conducted using the WhatsApp messaging application. Data were analyzed using the MAXQDA software version 2020. Data analysis resulted in the emergence of three categories consisting of psychological responses to the pandemic and the behavioral and psychological responses to the quarantine. Most of the extracted themes are related to students' psychological reactions to the pandemic. During the quarantine period, students suffered from uncertainty, experienced boredom, worried about delay in their graduation, and were concerned about losing employment opportunities. Medical students must be prepared for crisis situations like the present pandemic. We recommend that online courses and training programs be developed with the aim of offsetting the negative effects of university closure on students' education and skill training.

Predictors of low birth satisfaction among Iranian postpartum women: A cross-sectional study.

AIM: To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women. DESIGN: This was a cross-sectional study. METHODS: This study was conducted on 767 postpartum women using a convenience sampling method between June and September 2019. We collected data on socio-demographic variables, maternal well-being, fear of childbirth and birth satisfaction. We used multiple linear regression analyses to determine predictors of low birth satisfaction. RESULTS: The women who gave birth by elective caesarean, emergency caesarean and vaginal birth were 13.2%, 19.06% and 67.8%, respectively. Predictors of low birth satisfaction were primiparity [Beta = -0.131, CI (-2.745, -1.021)], low level of well-being [-0.119, (-2.514, -0.844)], low [-0.193 (-5.052, -2.568)] and moderate [-0.143 (-2.999, -1.199)] satisfaction with pregnancy, moderate satisfaction with spouse's emotional/financial support [-0.150 (-3.718, -1.595)], emergency caesarean [-0.086 (-2.713, -0.360)], severe fear of childbirth [-0.315 (-5.701, -3.911)] and long interval between admission to hospital and giving birth [-0.188 (-0.233, -0.119)].

Students' perspectives on the virtual teaching challenges in the COVID-19 pandemic: A qualitative study.

BACKGROUND: The COVID-19 pandemic led to the closure of crowded places such as universities and replaced face-to-face learning with virtual education. The purpose of this qualitative study was to investigate the challenges of virtual learning from the students' perspectives. MATERIALS AND METHODS: This qualitative descriptive study was conducted on students of Sabzevar University of Medical Sciences. Purposeful sampling was performed by semi-structured group interviews on the Internet in the WhatsApp social network. Fifty-two nursing, midwifery, hygiene, and paramedical students were interviewed. Every interview was started by asking the question "what is your experience about virtual teaching?" The data were analyzed using MAXQDA software version 2020. According to the steps of qualitative content analysis, content analysis was performed and the themes were extracted. RESULTS: Fifty-two students were interviewed in eight group sessions. Qualitative data analysis leads to the extraction of 23 codes, 7 categories, and the 2 main themes; dissatisfaction with virtual education with 4 categories (lack of feedback, communication channel problems, the unpreparedness of the message receiver, and weakness in educational content) and solutions to the modification of virtual teaching with three categories (possibility of receiving feedback, channel improvement, and strengthening educational content) were extracted. The highest frequency of code was related to the dissatisfaction with the uploaded contents. CONCLUSIONS: Virtual education has created a negative experience among students for various reasons, including the lack of distance learning infrastructure and the lack of a standard for preparing quality content. Therefore, it is necessary for the officials of the Education Development Center to supervise the prepared contents and improve distance learning infrastructure.

Fatigue in Pregnancy: The validity and reliability of the Farsi Multidimensional Assessment of Fatigue scale.

OBJECTIVES: Fatigue is a common discomfort experienced during pregnancy and may contribute to severe labour pain and postpartum depression. This study aimed to translate the Multidimensional Assessment of Fatigue (MAF) scale into Farsi and validate it in a sample of pregnant Irani women. METHODS: This cross-sectional questionnaire study was conducted between January and June 2016 at eight healthcare centres in Sabzevar, Iran. The English version of the MAF scale was translated into Farsi and assessed for content validity. Participants completed the Farsi MAF scale and the Farsi World Health Organization-5 Well-being index (WHO-5). Construct validity was assessed through exploratory factor analysis (EFA). Cronbach's alpha coefficient and the intraclass correlation coefficient (ICC) were used to determine the internal consistency and stability of the Farsi MAF scale. RESULTS: A total of 582 women met the inclusion criteria, of which 541 completed the MAF scale (response rate: 93%). The EFA of the 15 items confirmed the previously proposed one-factor structure with a Cronbach's alpha coefficient of 0.957 for the Farsi MAF scale. Stability was confirmed by the ICC value (0.702) for the Global Fatigue Index (GFI) and the mean GFI was 20.33 ± 12.71. Concurrent validity was confirmed by a moderate negative correlation (r = -0.35; P <0.001) between the scores of the Farsi MAF scale and the Farsi WHO-5. Women who received a high level of support from their husbands, who were satisfied with the quality of their marital relationship and with a well-being score of >50 reported a lower level of fatigue than the other groups (P ≤0.012). CONCLUSION: The Farsi MAF scale is a reliable and valid questionnaire to investigate fatigue in pregnant Irani women. Interventions to promote marital satisfaction and women's well-being are recommended.

Childbirth Fear and Associated Factors in a Sample of Pregnant Iranian Women.

OBJECTIVES: Fear of childbirth is common during pregnancy and may contribute to several adverse outcomes. We aimed to investigate childbirth fear and associated factors in a sample of pregnant Iranian women. METHODS: This cross-sectional study was conducted on 525 pregnant women in Sabzevar, Iran from December 2016 to March 2017. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) was used to investigate fear of childbirth. RESULTS: The mean W-DEQ score was 67.6±23.5. Of 525 women, 19.6% and 6.1% experienced moderate (mean W-DEQ score ≥ 85) and severe (mean W-DEQ score ≥ 100) fear of childbirth, respectively. W-DEQ scores were not different in the categories of gestational age, parity, maternal age, educational level, body mass index, and employment status (p > 0.050). The mean score of childbirth fear was significantly higher in multiparas who preferred cesarean in comparison to those who preferred vaginal delivery (p < 0.032). The mean score of childbirth fear was significantly higher in nulliparas with a lower family income compared to those with a higher family income (p < 0.011). In nulliparas, predictors of moderate and severe childbirth fear were women's description of their present pregnancy (odds ratio (OR) = 2.600; 95% confidence interval (CI): 1.323-5.112), and receiving a low level of emotional support from their husband (OR = 4.450; 95% CI: 1.349-14.674), respectively. In multiparas, predictors of childbirth fear were unwanted pregnancy (OR = 2.930; 95% CI: 1.549-3.541), experiencing moderate to severe dyspareunia in the first intercourse (OR = 2.829; 95% CI: 1.479-5.414), having a low level of physical activity (OR = 1.942; 95% CI: 1.014-3.716), and perceived a low level of health (OR = 3.415; 95% CI: 1.172-9.950). CONCLUSIONS: We observed a relatively high prevalence of childbirth fear in pregnant women in Iran. Interventions should be implemented in high-risk women considering psychological variables.

Comparison of vaginal misoprostol, laminaria, and isosorbide dinitrate on cervical preparation and labor duration of term parturient: a randomized double-blind clinical trial.

BACKGROUND: Cervical ripening plays an important role in successful labor induction. OBJECTIVE: This study aimed to compare the effects of misoprostol, laminaria tent, and isosorbide dinitrate (ISDN) on cervical ripening. METHODS: This double-blind three-armed clinical trial was conducted at Shahidan Mombini Teaching Hospital in Sabzevar, Iran, in 2016 on 96 singleton term pregnant women. Participants were randomly allocated to receive either two 20-mg ISDN tablets vaginally every 4 hours for a maximum of three doses or 25 mcg misoprostol vaginally every 6 hours for a maximum of two doses or laminaria tent for a maximum of 12 hours. The method of randomization was covariate adaptive randomization and the primary outcome measures were Bishop Score changes and labor duration. SPSS software version 18 was used for statistical analyses. Kruskal-Wallis, chi-square and ANOVA tests were applied for data analyses. RESULTS: Bishop Score changes were higher in the misoprostol group than in the two other groups (p=0.014). Time from start of medication to active phase of labor and delivery were 6.22±3.11 and 11.78±5.3 minutes in the misoprostol group, 11.25±3.07 and 17.62±4.07 minutes in the laminaria group, and 10.12±3.48 and 17.37±4.79 minutes in the ISDN group respectively (p<0.001). Cesarean rate was higher in the misoprostol group than the two other groups (p=0.016). No significant differences were observed between the study groups in terms of Apgar score and meconium-stained amniotic fluid. CONCLUSIONS: Use of misoprostol results in more improvement of Bishop Score and reduced length of labor phases in comparison to laminaria tent and ISDN. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016050527643N2 in the Iranian Registry of Clinical Trials IRCT2015040921670N1. FUNDING: The authors received no financial support for the research, authorship, and/or publication of this article.

Validity and reliability of the Farsi version of Wijma delivery expectancy questionnaire: an exploratory and confirmatory factor analysis.

BACKGROUND: Fear of childbirth may cause complications such as experiencing severe labour pain, postpartum depression, and impaired mother-fetus attachment. OBJECTIVE: To validate the Farsi version of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) (versions A & B) in a sample of Iranian women. METHODS: The WDE-Q (versions A & B) was translated into Farsi, and the content validity of the scales was confirmed. In a cross-sectional study conducted in 2015, 405 pregnant women in the third trimester of pregnancy and 320 postpartum women completed the Farsi W-DEQ versions A & B, respectively. The construct validity and reliability of the scales were examined using exploratory and confirmatory factor analyses (EFA and CFA) and Cronbach's alpha coefficient, respectively. SPSS version 18 and Lisrel version 8.80 were used for statistical analyses. RESULTS: Results of the CFA on 33 items could not confirm the one-factor structure proposed by Wijma (RMSEA= 0.14, SRMR=0.11, Chi-square/df=8.95, p<0.05, CFI=0.86, IFI=0.86) or other structures suggested by previous studies. We conducted an EFA on 33-item version A and found six factors with eigenvalue > 1. One item was not loaded on any factor. A CFA on 32 items of the W-DEQ (version B) yielded acceptable fit for the factorial structure found on version A (RMSEA= 0.075 (CI [0.071, 0.08]), SRMR=0.078, Chi-square/df=2.93, p<0.05, CFI=0.95, IFI=0.95). Cronbach's Alpha coefficients for the 32-item Farsi W-DEQ (versions A & B) were 0.914 and 0.919, respectively. CONCLUSIONS: Both Farsi W-DEQ are reliable and valid instruments to assess fear of childbirth in Iranian pregnant and postpartum women. Further research should be designed to examine the validity of the W-DEQ (A) in pregnant women regardless of gestational age.

Comparison of umbilical artery Doppler and non-stress test in assessment of fetal well-being in gestational diabetes mellitus: A prospective cohort study.

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is related to poor perinatal outcomes. Reduction of neonatal complications of GDM is feasible by assessment of fetal well-being. Both fetal Doppler and NST are used for the screening of high-risk pregnancies. OBJECTIVE: We aimed to compare the non-stress test (NST) and umbilical artery (UA) Doppler assessments for evaluation of the adverse perinatal outcomes in GDM. METHODS: We conducted a prospective cohort study on 50 pregnant women with GDM in Jame Zanan Hospital, Tehran, Iran, from Oct 2014 to Sep 2015. A convenient sampling method was used for patient recruitment. Inclusion criteria were women with GDM, singleton pregnancies, and gestational age>32 weeks who had neither medical conditions nor fetal anomalies. Adverse perinatal outcomes were defined as Apgar scores at 1-min and 5-min <7, hypoglycemia (blood glucose <45 mg/dl), neonatal acidosis (PH<7.2), hypocalcemia (Ca<8 mg/dl), admission to the NICU for more than 24 hours, and perinatal death. Statistical analyses were performed with SPSS version 16 using Chi-square, Fisher's exact test, and independent-samples t-test. The significance level was considered at 0.05. RESULTS: Totally, 22% and 12% of women had an abnormal UA Doppler and a non-reactive NST respectively. Poor outcomes were detected in 13 women. The most frequent poor outcomes were hypoglycemia (n=9), Apgar 1-min <7 (n=8), neonate admitted in NICU (n=6), and respiratory distress syndrome (n=6). Poor outcome was more prevalent in women with non-reactive NST (p<0.001), abnormal UA Doppler (p=0.033), and those with infant birth weight >4000 gram (p=0.033). Sensitivity and specificity of the NST in predicting different poor outcomes were 76.9% and 97.3% respectively. Sensitivity and specificity of UA Doppler in predicting different poor outcomes were 30.8% and 94.6% respectively. CONCLUSION: NST is a better predictor of adverse perinatal outcomes in GDM patients.

Worries of Pregnant Women: Testing the Farsi Cambridge Worry Scale.

Pregnancy adds many sources of concerns to women's daily life worries. Excessive worry can affect maternal physiological and psychological state that influences the pregnancy outcomes. The aim of this study was to validate the Cambridge Worry Scale (CWS) in a sample of Iranian pregnant women. After translation of the CWS, ten experts evaluated the items and added six items to the 17-item scale. In a descriptive cross-sectional study, 405 of pregnant women booked for prenatal care completed the Farsi CWS. We split the sample randomly. Exploratory factor analysis (EFA) was conducted on the first half of the sample to disclose the factorial structure of the 23-item scale. The results of the EFA on the Farsi CWS indicated four factors altogether explained 51.5% of variances. Confirmatory factor analysis (CFA) was done on the second half of the sample. The results of the CFA showed that the model fit our data (chi-square/df = 2.02, RMSEA = 0.071, SRMR = 0.071, CFI = 0.95, and NNFI = 0.94). Cronbach's alpha coefficient for the Farsi CWS was 0.883. The Farsi CWS is a reliable and valid instrument for understanding common pregnancy worries in the third trimester of pregnancy in Iranian women.

The Effect of Slow-Stroke Back Massage on the Anxiety Levels of Iranian Women on the First Postpartum Day.

BACKGROUND: Anxiety disorder is common during the postpartum period. Back massage relaxation techniques are one of the most important nonpharmacological interventions to prevent and control postpartum-related anxiety. OBJECTIVES: To determine the effectiveness of slow-stroke back massage on the anxiety levels of primiparous mothers in the first days after delivery. MATERIALS AND METHODS: This single-blind controlled clinical trial consisted of 100 primiparous mothers with normal deliveries. The mothers were randomly allocated to interventional (n = 50) or control (n = 50) groups using binary blocks. Both groups were followed up just before, immediately after, and the morning after the intervention. Data were collected using a demographic questionnaire and Spielberger's state anxiety inventory (STAI) questionnaire. RESULTS: The mean age of the mothers was 22 years. There were no significant between-group differences in age (P = 0.333), education (P = 0.427), and medication during labor and the postpartum period (P = 0.412). There was no statistically significant difference between the mean anxiety scores of the experimental (6.66 ± 35.48) and control groups (9.05 ± 37.42) before the intervention (P = 0.268). Immediately after the massage and the next morning, there was a significant between-group difference in the anxiety scores (P < 0.001). CONCLUSIONS: The findings demonstrate that slow-stroke back massage is a simple, inexpensive, noninvasive, and effective method to reduce the anxiety levels of primiparous women during the first postpartum day.

Psychometric Properties of the Procrastination Assessment Scale-Student (PASS) in a Student Sample of Sabzevar University of Medical Sciences.

BACKGROUND: Procrastination is a common behavior which affects different aspects of life. The procrastination assessment scale-student (PASS) evaluates academic procrastination apropos its frequency and reasons. OBJECTIVES: The aims of the present study were to translate, culturally adapt, and validate the Farsi version of the PASS in a sample of Iranian medical students. PATIENTS AND METHODS: In this cross-sectional study, the PASS was translated into Farsi through the forward-backward method, and its content validity was thereafter assessed by a panel of 10 experts. The Farsi version of the PASS was subsequently distributed among 423 medical students. The internal reliability of the PASS was assessed using Cronbach's alpha. An exploratory factor analysis (EFA) was conducted on 18 items and then 28 items of the scale to find new models. The construct validity of the scale was assessed using both EFA and confirmatory factor analysis. The predictive validity of the scale was evaluated by calculating the correlation between the academic procrastination scores and the students' average scores in the previous semester. RESULTS: The corresponding reliability of the first and second parts of the scale was 0.781 and 0.861. An EFA on 18 items of the scale found 4 factors which jointly explained 53.2% of variances: The model was marginally acceptable (root mean square error of approximation [RMSEA] =0.098, standardized root mean square residual [SRMR] =0.076, χ(2) /df =4.8, comparative fit index [CFI] =0.83). An EFA on 28 items of the scale found 4 factors which altogether explained 42.62% of variances: The model was acceptable (RMSEA =0.07, SRMR =0.07, χ(2)/df =2.8, incremental fit index =0.90, CFI =0.90). There was a negative correlation between the procrastination scores and the students' average scores (r = -0.131, P =0.02). CONCLUSIONS: The Farsi version of the PASS is a valid and reliable tool to measure academic procrastination in Iranian undergraduate medical students.

[Validation of the World Health Organization-5 Well-Being Index; assessment of maternal well-being and its associated factors]. / Dünya Saglik Örgütü-5 Iyilik Hali Endeksi Geçerligi:Annenin Iyilik Hali ve Bununla Iliskili Faktörlerin Degerlendirilmesi.

OBJECTIVE: The aim of this study was to validate the World Health Organization-5 Well-Being Index (WHO-5) in a sample of pregnant Iranian women, to explore the changes in maternal well-being from pregnancy to postpartum, and to determine the factors associated with maternal well-being. MATERIALS AND METHODS: This study included 341 pregnant women that presented to healthcare centers affiliated with Shahroud University of Medical Sciences, Iran, in 2011. The participants completed the General Health Questionnaire (GHQ-28) and Farsi version of WHO-5 during the third trimester of pregnancy and at 2 months postpartum. RESULTS: Cronbach's alpha coefficient for WHO-5 items was 0.85. The correlation coefficient between WHO-5 and GHQ-28 was -0.64 (P < 0.001). Exploratory factor analysis yielded 1 factor with an eigen value equal to 3.15, which explained 63.1% of the total variance. Confirmatory factor analysis confirmed the 1-factor structure. The area under ROC curve was 0.82. A WHO-5 cut-off score of <50 exhibited optimal sensitivity (0.84) and specificity (0.59) for identifying psychological symptoms (GHQ-28 score ≥24). There was a significant difference between third trimester (58.4 ± 22) and postpartum (64.1 ± 22.3) mean WHO-5 scores (P < 0.001). Maternal level of education (OR = 1.130; 95% CI: 1.307, 1.232) was the only predictor of maternal well-being during third trimester. Breastfeeding difficulty (OR = 0.923; 95% CI: 0.882, 0.965) and maternal well-being scores during third trimester (OR = 1.038; 95% CI: 1.019, 1.058) were predictors of maternal well-being during the postpartum period. CONCLUSIONS: The Farsi version of WHO-5 was observed to be a reliable and valid instrument for screening psychological symptoms in pregnant Iranian women. The present findings show that maternal well-being improved following childbirth.

Breastfeeding practices during the first month postpartum and associated factors: impact on breastfeeding survival.

BACKGROUND: The introduction of fluids to infants during the first days postpartum, which may be harmful to infant health, is a common practice in Iran. OBJECTIVES: This study aimed to find the prevalence of breastfeeding practices using monthly dietary recall and factors associated with introduction of fluids during the first month of life and determine the effects of these supplementations on breastfeeding survival. PATIENTS AND METHODS: This longitudinal study carried out in Shahroud, Iran from May 2011 to October 2013. Using convenient sampling strategy, 358 mothers in their third trimester of pregnancy were enrolled in the study and completed the questionnaires. Then the data regarding the introduction of fluids during first month postpartum was collected. We followed women monthly up to breastfeeding cessation. Kaplan-Meier and time-to-event methods were used to assess breastfeeding survival. A multinomial logistic regression analysis was used to identify the variables that determined breastfeeding practices at the first month postpartum. The Cox regression analysis was used to estimate the effect of variables on breastfeeding survival. RESULTS: The prevalence of exclusive, predominant, and partial breastfeeding during the first month postpartum were 33.1%, 58.2%, and 8.6%, respectively. Predominant breastfeeding was associated with the lack of breastfeeding experience (OR = 1.93; 95% CI [1.02 - 3.66]). Partial breastfeeding was associated with the maternal age ≥ 30 y (OR = 5.96; CI [1.66 - 21.37]), family income higher than the mean (OR = 3.39; 95% CI [1.17 - 9.81]), and breastfeeding difficulties score higher than mean (OR = 3.09; 95% CI [1.10 - 8.71]). The Cox regression analysis revealed that breastfeeding practices at the first month was associated with an increased risk for breastfeeding discontinuation. The hazard ratio of breastfeeding discontinuation for predominant and partial breastfeeding groups were 1.11 (95% CI: 0.82, 1.51; P = 0.49) and 2.23 (95% CI: 1.39, 3.58; P = 0.001), respectively compared to the exclusive group. CONCLUSIONS: The prevalence of predominant breastfeeding during the first month postpartum is high in Shahroud. Interventions to strengthen adherence to WHO guidelines for breastfeeding should be considered. Breastfeeding education providers at the hospitals should emphasize the effects of formula on breastfeeding continuation at early postpartum.