基于正念的心身保健课程对分娩恐惧孕妇的影响:多中心随机对照研究

Impact of mindfulness-based psychosomatic health course on pregnant women with fear of childbirth: a multi-center randomized controlled trial

摘要

目的 评估基于正念的心身保健课程对分娩恐惧孕妇的干预效果。方法 2023年4月至11月期间于山东省妇幼保健院、山东省立医院、山西省妇幼保健院招募研究对象,随机分为干预组和对照组.干预组接受基于正念的心身保健课程,对照组接受常规孕产期保健课程.采用分娩预期经历量表(W-GDEQ)、正念五因素量表(FFMQ)分别在干预前、干预后、产后3天对孕产妇进行测评,采用混合线性模型比较两组孕妇的分娩恐惧、正念水平的变化情况。结果 两组孕妇的人口学资料、量表基线测评结果无显著性差异(P＞0.05).干预组孕妇在干预后和产后3天分娩恐惧得分分别降低了11.24、13.53分,正念得分分别提高了7.93、4.53分,差异均有统计学意义(P＜0.05);而干预后对照组分娩恐惧得分变化无统计学意义(P＞0.05),正念得分降低了2.46、2.89分,差异有统计学意义(P＜0.05).同时,干预后和产后3天干预组孕妇的分娩恐惧均低于对照组,正念得分均高于对照组,差异均有统计学意义(F_组别值分别是9.823、6.180,P＜0.05).两组分娩方式、产程差异无统计学意义(P＞0.05),但干预组分娩镇痛使用比例低于对照组.亚组分析进一步发现,自然分娩孕妇中干预组第二产程催产素使用比例低于对照组,差异有统计学意义(χ²值为9.191,P＜0.05)。结论 基于正念的心身保健课程可以改善分娩恐惧水平、提高分娩恐惧孕妇的正念水平,降低分娩镇痛使用比例及第二产程催产素使用比例.

Abstract

Objective To evaluate the intervention effects of a mindfulness-based psychosomatic health course on pregnant women with fear of childbirth. Methods From April to November 2023, subjects were recruited from Shandong Provincial Maternal and Child Health Care Hospital, Shandong Provincial Hospital and Women Health Center of Shanxi were randomly divided into intervention group and control group. The intervention group received mindfulness-based psychosomatic health course, while the control group received routine maternal health care course. The Wijma delivery expectancy/experience questionnaire (W-GDEQ) and five facet mindfulness questionnaire (FFMQ) were used to evaluate pregnant women before intervention, after intervention and three days after delivery. Mixed linear models were used to analyze and compare changes in childbirth fear and mindfulness levels between the two groups. Results There were no significant differences in baseline demographic characteristics and scale scores between the two groups (P＞0.05). After intervention and three days after delivery, the scores of fear of childbirth in the intervention group decreased by 11.24 and 13.53 points, respectively, while the scores of mindfulness increased by 7.93 and 4.53 points, respectively, with the statistically significant difference (P＜0.05). However, there was no statistically significant change in the score of fear of childbirth in the control group after intervention (P＞0.05) and the score of mindfulness decreased by 2.46 and 2.89 points with the statistically significant difference (P＜0.05). At the same time, after intervention and three days after delivery, the scores of fear of childbirth in the intervention group were lower than that in the control group and the mindfulness scores was higher than that those of the control group, with the statistically significant difference (F_group=9.823 and 6.180, respectively, P＜0.05). There were no significant differences in delivery mode or labor duration between the two groups (P＞0.05), but the intervention group had a lower proportion of analgesic use during labor. Subgroup analysis further showed that among women undergoing natural childbirth, the intervention group had a lower proportion of oxytocin use during the second stage of labor compared to the control group, with statistical significance (χ²=9.191, P＜0.05). Conclusion Mindfulness-based psychosomatic health courses can improve the level of fear of childbirth, increase mindfulness level in pregnant women with fear of childbirth, and reduce the proportion of analgesic and oxytocin use during the second stage of labor.

关键词

分娩恐惧 / 正念 / 孕妇 / 随机对照研究 / 维度

Key words

fear of childbirth / mindfulness / pregnant women / randomized controlled trial / dimension

参考文献

[1] Sheen K, Slade P. Examining the content and moderators of women's fears for giving birth: a meta-synthesis[J]. J Clin Nurs, 2018, 27(13-14): 2523-2535.

[2] Dencker A, Nilsson C, Begley C, et al. Causes and outcomes in studies of fear of childbirth: a systematic review[J]. Women Birth, 2019, 32(2): 99-111.

[3] Huang J, Huang J, Li Y, et al. The prevalence and predictors of fear of childbirth among pregnant Chinese women: a hierarchical regression analysis[J]. BMC Pregnancy Childbirth, 2021, 21(1): 643.

[4] Han YT, Zhao GL. Effects of childbirth rehearsal combined with 3D technology on the delivery of primiparas[J]. J Nurs Sci, 2020, 35(18): 26-28.

[5] O'Connell MA, Khashan AS, Leahy-Warren P, et al. Interventions for fear of childbirth including tocophobia[J]. Cochrane Database Syst Rev, 2021, 7(7): CD013321.

[6] Duncan LG, Cohn MA, Chao MT, et al. Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison[J]. BMC Pregnancy Childbirth, 2017, 17(1): 140.

[7] Sun Y, Li Y, Wang J, et al. Effectiveness of smartphone-based mindfulness training on maternal perinatal depression: randomized controlled trial[J]. J Med Internet Res, 2021, 23(1): e23410.

[8] Wang SL, Sun MY, Huang X, et al. Benefits of mindfulness training on the mental health of women during pregnancy and early motherhood: a randomized controlled trial[J]. Biomed Environ Sci, 2023, 36(4): 353-366.

[9] Veringa-Skiba IK, de Bruin EI, van Steensel FJA, et al. Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: a randomized controlled trial comparing mindfulness-based childbirth and parenting with enhanced care as usual[J]. Birth, 2022, 49(1): 40-51.

[10] Sbrilli MD, Duncan LG, Laurent HK. Effects of prenatal mindfulness-based childbirth education on childbearers' trajectories of distress: a randomized control trial[J]. BMC Pregnancy Childbirth, 2020, 20(1): 623.

[11] 王淑蕾, 刘艳君, 孙梦云, 等. 中国本土化正念课程对孕产妇分娩恐惧干预效果的多中心随机对照研究[J]. 中国妇幼健康研究, 2022, 33(8): 87-93.

[12] Kuo TC, Au HK, Chen SR, et al. Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: a single-blind randomised controlled trial[J]. Midwifery, 2022, 113: 103438.

[13] Kang H. Sample size determination and power analysis using the G*Power software[J]. J Educ Eval Health Prof, 2021, 18: 17.

[14] Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth[J]. J Psychosom Obstet Gynaecol, 1998, 19(2): 84-97.

[15] Deng YQ, Liu XH, Rodriguez MA, et al. The five facet mindfulness questionnaire: psychometric properties of the Chinese version[J]. Mindfulness, 2011, 2(2): 123-128.

[16] Duncan LG, Bardacke N. Mindfulness-based childbirth and parenting education: promoting family mindfulness during the perinatal period[J]. J Child Fam Stud, 2010, 19(2): 190-202.

[17] Lönnberg G, Jonas W, Unternaehrer E, et al. Effects of a mindfulness based childbirth and parenting program on pregnant women's perceived stress and risk of perinatal depression-results from a randomized controlled trial[J]. J Affect Disord, 2020, 262: 133-142.

基金资助

国家重点研发计划项目(2022YFC2703800)