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The Effect of Fear and Psychological Anxiety on Women who are about to Give Birth in the Last Months of Pregnancy

Wafaa Mohammed Abed

M.B.Ch.B., High Diploma Gyn & Obst., Master ART., PhD Infertility and Clinical Reproductive Al- Kut Teaching Hospital, Ministry of Health, Iraq

Email: [email protected] Abstract

Background: Anxiety is still as one of the one of the most important topics of concern to many specialists in the branches of various scientific studies. The interest of studying anxiety in part is due to the negative consequences as it causes a wide spectrum psychological disorders in both sexes and perhaps in women in particular the biggest and perhaps the most important factor affecting a pregnant woman. The upcoming birth is what we mentioned earlier, which is anxiety being the first emotional response in the lexicon of situations especially in this period.

Objectives: Find out if the woman who is about to give birth suffers from psychological anxiety and shed light on the most important physical and psychological symptoms of psychological anxiety for the woman who is due to give birth.

Materials and methods: This research was conducted on a randomly selected sample of women about to give birth in Al-Kut Maternity Hospital in Wasit Governorate, the number of examinations reached 100 during 12/1/2021 to 20/1/2021.

Results: Physiological and physical symptoms were conducted on 100 samples of pregnant women in the last months of pregnancy and the percentages were divided into three sections high, medium and rare. The physical symptoms included shortness of breath - dry mouth and throat-feeling cold in the hands- suffering from constant constipation- chest pain and dizziness- persistent headache, and the high rate ranged between (5-60%). While the physiological symptoms included 11 choices, the percentages ranged between 0 - 90%.

Conclusion: Psychological anxiety accompanies a person at all stages His life, especially pregnant women, and the severity of anxiety varies according to the extent to which the physiological and physical symptoms of anxiety dominate the pregnant woman.

Keywords: Anxiety, Fear, Psychological anxiety, Pregnancy, Pregnancy outcome

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Introduction

Anxiety is an unpleasant emotional experience experienced when an individual feels fear or limitation about something without being able to this condition is often accompanied by some physiological changes [1].

In general, it is an individual's feeling of constant terror and fear as a result of certain values that he holds the individual is inside him, and from external events that do not justify the presence of this feeling, anxiety may mean a group of feelings and emotional feelings that include fear, pain and bad expectations, and it is a painful emotional experience that he suffers from when an individual feels fear or threat of something without being able to define it accurately or clearly [2]. Symptoms of anxiety are divided into physical and psychological. These include general weakness, lack of vital energy, vigor, perseverance, muscle tension, and excessive motor activity Crises, motor nervousness, constant headaches, sweat, shoulder sweat, and pallor of the face Rapid pulse, chest pain, high blood pressure, respiratory disturbance, squeezing, and feeling tight Chest and turn, nausea, vomiting, coughing, loss of appetite, insomnia, and dreams nagging and disturbed sexual function, As for psychological symptoms, they include general anxiety and anxiety about health and work the future, nervousness, general tension, and psychological sensitivity are excessive doubt, suspicion, hesitation, anxiety, fleeting depression, pessimism, and preoccupation with mistakes. The past, delusion of illness, poor concentration, wandering of the mind, poor ability to work and production, and poor social adjustment and professional mismatch, and the situation may reach random, uncontrolled behavior [3, 4].

A lack of adaptation may occur due to the disturbed personality of one of the spouses, or the lack of acceptance of the pregnancy, or the lack of support or an unusually large number of stressors, and the focus must be by healers on these concerns and problems from the start, and steps therapy can help a couple a lot psychological problems and disorders are more common in the mother during pregnancy and the puerperium, This is due to the combination of biological and chemical factors of pregnancy hormones and psychological stress, these disorders range from a mild disorder such as anxiety or postpartum depression to a severe one up to psychotic disorders such as schizophrenia [5, 6]. The psyche and behavior of the expectant mother is a mirror that reflects the hormonal disturbances inside her due to the presence of a new organism in her womb. Digestive disorders such as nausea and vomiting and psychological disorders change the mood appetite, and the husband is sometimes bored with the temporary care that she afflicts her

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for fear that she will miscarry as a result of marital occasions, and changes her mood towards her husband, and her behavior disorders, all of this makes the pregnant woman a sensitive and sensitive person, so she must dealing with her and cohabiting with her calmly and patiently during the first three months of her pregnancy, especially if she is pregnant with the first boy, and the pain was severe [7].

must also take care of her psychological condition during the other two months of pregnancy because she is afraid of giving birth premature or difficult childbirth, as well as conjugal occasions should be reduced, and even completely abstained during the last two weeks of the month pregnancy [8]. Labor and delivery are among the most difficult things that a pregnant mother may see with the eyes of the expectant mother, pain, trauma, as well as the direction of the difficult physical effort that she makes during the labor process, after the birth process and the emergence of the new organism that is largely responsible from the mother, there is a concern from the mother about the behavior that she should take towards this new organism. [9].

Therefore, it is necessary to support this educational aspect in some physical and some treatments the first is relaxation, and it begins with a type of intended breathing, followed by a competition with calm and relaxation the beginnings of childbirth require a lot of focus and effort by the pregnant woman, which is something that she cannot as a woman as she is It requires constant support from those around the mother and better than this is the method of spontaneous breathing and this is a method of self-relaxation and it results from the person who practices it and is free from fear and distress [10]. As a result of the above, the importance of the support provided by midwives or gynecologists for childbirth began to appear, this support is considered one of the services provided to the mother during the birth process, and all workers in the Birth field hurry to apply this support.

Materials and Methods

Multiple measures of anxiety were used, such as: Taylor Spielberger and Cattell, to benefit from them in preparing the study tool through the theoretical framework in which the researcher dealt with the issue of birth anxiety and some personal interviews conducted by the researcher with, mothers who attend the obstetrics department for the purpose of childbirth and not examination, as well as midwives and doctors responsible for the birth process.

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Results

The first axis: the physical symptoms of anxiety

Table 1: Physical symptoms of a pregnant woman in the last months of pregnancy Symptoms Significantly Moderately Rare

Shortness of breath 49 (49%) 39 (39%) 12 (12%)

Dry mouth and the throat 50 (50%) 33 (33%) 17 (17%)

Feeling cold in the hands 54 (54%) 41 (41%) 5 (5%)

Suffering from Constant constipation 44 (44%) 49 (49%) 7 (7%)

Chest pain and dizziness 60 (60%) 33 (33%) 7 (7%)

Constant headache 45 (45%) 39 (39%) 16 (16%)

Depending on the data contained in Table (1) the physical symptoms that were prevalent in pregnant women ranged significantly between (44-60%), and the symptoms that were present were (33-49%), and the physical symptoms that were present in rare cases were its ratio (5-17%).

The second axis: psychological symptoms of anxiety

Table 2: Physiological symptoms of a pregnant woman in the last months of pregnancy

Symptoms Significantly Moderately Rare

Concern about bleeding 70 (70%) 30 (30%) 0 (0%)

Feeling anxious about the lack of attention of the medical staff

67 (67%) 25 (25%) 8 (8%) Feeling afraid ofDifficulty giving birth 90 (90%) 10 (10%) 0 (0%) Anxiety about vaginal examination 66 (66%) 32 (32%) 2 (2%) Feeling afraid ofLoss of sense of fetal

movement inside the womb

57 (57%) 42 (42%) 1 (1%)

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Based on the data in Table (2) for the Physiological symptoms of a pregnant woman in the last months of pregnancy that were, their significantly ranged between (57-90%), and the symptoms that were present in a moderately were (10-42%), and as for the rare symptoms, their percentage was (0-8%).

Table 3: Physiological symptoms of a pregnant woman in the last months of pregnancy Symptoms Significantly Moderately Rare

Feeling anxious about the pain that accompanies birth process

43 (43%) 41 (41%) 16 (16%) Feeling anxious about lack amniotic fluid

surrounding the fetus

38 (38%) 37 (41%) 25 (25%) Loss of ability to focus 49 (49%) 38 (38%) 13 (13%)

Fear of the unknown 55 (55%) 37 (37%) 8 (8%)

interrupted sleep 59 (59%) 38 (38%) 3 (3%)

Feeling stressed and confused to the minimum reason

65 (65%) 32 (32%) 3 (3%)

Based on the data in Table (3) for the Physiological symptoms of a pregnant woman in the last months of pregnancy that were, their significantly ranged between (38-65%), and the symptoms that were present in a moderately were (32-41%), and as for the rare symptoms, their percentage was (3-25%).

Discussion

Through the responses of the examinees to the vocabulary of the second dimension of the questionnaire, it was found that most of the respondents chose the first alternative (to a large extent) to answer the elements of the questionnaire, and this proves its validity. the second partial hypothesis, which states that a woman who is about to give birth experiences psychological symptoms of anxiety.

Through the responses of the sample members to the questionnaire items divided into two dimensions: the physiological dimension and the psychological dimension of anxiety, which

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included the most important psychological and physiological symptoms that a woman who is about to give birth may suffer from. It was found by analyzing the results of the questionnaire that the examinees relied on the first alternative (to a large extent) in determining their answers to most of the items in the questionnaire, The response rates with this alternative ranged in most of the vocabulary, reaching 90% Large percentages prove that the woman who is about to give birth suffers from physiological and psychological symptoms that cause concern.

The result of the study conducted by the researcher was in agreement with previous studies on psychological anxiety and its relationships, by birth or its impact on it, such as the study conducted by Abdul Wahed and Ahmed, 2020 which aimed to identify the presence of symptoms of anxiety and depression in pregnant women, and the result of this study showed a high level of anxiety in pregnant women, Women more than others, as well as study by Wallace in 2016, which aims to research the effect of both depression and anxiety for a pregnant woman on her psychological state, and the result was consistent with the results of the research in the current study, as a pregnant woman suffers from anxiety and it affects it during pregnancy as well as during the birth process.

The study conducted by the researcher also agreed with the study Shahhosseini et al., 2015 which aimed to study the relationship between the level of anxiety in mothers and the control of their ability during the birth process, and the result was there is a negative relationship between intense anxiety in expectant mothers and their ability to control and control during childbirth.

Hence, we conclude that the study conducted by the researcher was in agreement with a number of previous studies, meaning that it is on the right path to research.

References

1- Braeken MAKA, Kemp AH, Outhred T, Otte RA, Monsieur GJ, and Jones A. Pregnant mothers with resolved anxiety disorders and their offspring have reduced heart rate variability: Implications for the health of children. PloS one. 2013;8(12) e83186.

2- Cho SJ, Hong JP, Lee JY, Im JS, Na KS, Park JE, and Cho MJ. Association between DSM-IV Anxiety Disorders and Suicidal Behaviors in a Community Sample of South Korean Adults. Psychiatry Investig. 2016 Nov;13(6):595-600.

3- Goodwin R.D., Fergusson D.M., and Horwood L.J. Association between anxiety disorders and substance use disorders among young persons: results of a 21-year longitudinal study. J. Psychiatr. Res. 2004;38(3):295–304.

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4- Hosseini SM, Biglan MW, Larkby C, Brooks MM, Gorin MB, and Day NL. Trait anxiety in pregnant women predicts offspring birth outcomes. Paediatr Perinat Epidemiol. 2009;23:557–66.

5- Kane HS, Schetter CD, Glynn LM, Hobel CJ, and Sandman CA. Pregnancy anxiety and prenatal cortisol trajectories. Biological psychology. 2014;100:13–19.

6- Parfitt Y, Ayers S. Transition to parenthood and mental health in first-time parents. Infant Mental Health Journal. 2014; 35(3): 263-273.

7- Preis H, Inman E, and Lobel M. Contribution of psychology to research, treatment, and care of pregnant women with opioid use disorder. American Psychologist 2020.

10.1037/amp0000675.

8- Watson D. Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. J Abnorm Psychol. 2005;114(4):522–536

9- Wittchen HU, J acobi F, and Rehm J.The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;9:655–679.

10- Shahhosseini Z, Pourasghar M, Khalilian A, and Salehi F. A Review of the Effects of Anxiety During Pregnancy on Children's Health. Mater Sociomed. 2015;27(3):200-202.

doi:10.5455/msm.2015.27.200-202.

11- Abdulwahid R G, and Ahmed HM. Nutritional characteristics of pregnant women and its relation with anemia during pregnancy in a sample of Kurdish women/Iraq. Cihan University-Erbil Scientific Journal, 2020 4(1), 37–44.

12- Berthelot N, Lemieux R, Garon-Bissonnette J, Drouin-Maziade C, Martel É, Maziade M.

and Berthelot N. Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. Acta Obstet Gynecol Scand. 2020 Jul;99(7):848-855. doi: 10.1111/aogs.13925. Epub 2020 Jun 3. Acta Obstet Gynecol Scand. 2020. PMID: 32449178.

13- Wallace ME, Hoyert D, Williams C, and Mendola P. Pregnancy-associated homicide and suicide in 37 US states with enhanced pregnancy surveillance. American Journal of Obstetrics and Gynecology. 2016;215(3): e1-364.e10.

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