Does Antenatal Fear of Childbirth Predict Postnatal Fear of Childbirth? A Study of Japanese Women

The study aimed to determine whether antenatal fear of childbirth (expectation) could predict postnatal fear of childbirth (experience) by taking account of other antenatal psychological variables (anxiety and depression) as well as birth outcomes in Japanese women. A longitudinal observational study was conducted at a clinic in Tokyo, Japan, in 2011. Self-report questionnaires were distributed to 240 Japanese women at 37 gestational weeks (Time 1) and on the second day after delivery (Time 2). Regression analyses by means of structural equation modelling were conducted in both the primiparous and the multiparous group. The models exhibited good fit (chisquare value/degree of freedom = 1.10 - 1.62, comparative fit index = 0.92 - 0.99 and root mean square error of approximation = 0.03 - 0.07). Antenatal fear of childbirth was the most predictive variable of postnatal fear of childbirth in both the primiparous (β = 0.58, p = 0.002) and the multiparous group (β = 0.62, p < 0.001). In conclusion, antenatal fear of childbirth was a significant predictor of postnatal fear of childbirth when other antenatal psychological variables and birth outcomes were taken into account. Pregnant women who are strongly afraid of childbirth need special attention before and after delivery.

Pelvic floor function and advanced maternal age at first vaginal delivery

Purpose: The study aimed to show differences in temporal recovery of pelvic floor function within 6 months postpartum between women having their first delivery at an advanced age and those having their first delivery at a younger age. Methods: Seventeen women (age: 35.5 ± 3.5, BMI: 21.1 ± 3.2) were studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form. Pelvic floor function was assessed by the anteroposterior diameter of the levator hiatus using transperineal ultrasound. Women who delivered for the first time at 35 years and/or older were defined as being of advanced maternal age. Results: Nine of 17 women (52.9%) were of advanced maternal age and 5 experienced postpartum stress urinary incontinence. Four of these 5 women (80.0%) were of advanced maternal age. The anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 3 and 6 months postpartum (p < 0.01). Among the continent women, the anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 6 months postpartum (p = 0.004). However, among the advanced maternal age women, all parameters of the anteroposterior diameter of the levator hiatus were not significantly different between the women with and without stress urinary continence. Conclusion: Recovery of pelvic floor function following delivery may be delayed in women of advanced maternal age at first delivery because of the damage to the pelvic floor during pregnancy and vaginal delivery, resulting in increase in the incidence of stress urinary incontinence.

The effects of an exercise program on health-related quality of life in postpartum mothers: A randomized controlled trial

Background and Objective: There is controversy on the psychological effects of postpartum exercise. The study aimed to evaluate the effectiveness of a postpartum exercise program on health-related quality of life and psychological well-being. Methods: We conducted a randomized controlled trial in Tokyo, Japan. The intervention groups participated in ball-exercise classes (weekly exercise of 90 minutes for four weeks) at three months postpartum. The exercise class included the following: 1) greeting and warm-up;2) aerobic exercise involving bouncing on an exercise ball 55 or 65 cm in diameter;3) rest and self-introduction;4) stretching and cooling down. The primary outcome measure was health-related Quality of Life (QOL) assessed using the MOS Short-Form 36-Item Health Survey (SF-36v2). The secondary outcome measures were Rosenberg Self-Esteem Scale (RSES) and Edinburgh Postnatal Depression Scale (EPDS) scores. The intervention group was compared to the control group at four months postpartum. Results: Of the 120 women screened, 110 women met the study criteria. Nine could not be included and the remaining 101 were allocated randomly into intervention and control groups (50 and 51 participants respectively). Analysis of covariance adjusting for baseline values indicated that the SF36 subscales of physical functioning (p = 0.018) and vitality (p = 0.016) significantly improved in the intervention group compared to the control group, although there were no significant differences between the groups in the SF36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. The RSES increased in the intervention group (p = 0.020) compared to the control group. No significant group differences were observed in EPDS scores. Conclusions: The postpartum exercise class program provided to healthy postpartum women appears to have contributed to promoting health-related QOL and self-esteem.

Psychometric Evaluation of the Japanese Wijma Delivery Expectancy/Experience Questionnaire Version B

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely accepted approach to measuring fear of childbirth and is available in two versions: antenatal (version A) and postnatal (version B). The aim of this study was to develop the Japanese W-DEQ version B and confirm its validity and reliability among Japanese women. A self-administered questionnaire incorporating the translated Japanese W-DEQ (JW-DEQ) version B and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) was distributed to Japanese mothers at two days postpartum. Of the 246 women recruited, 231 who completed the questionnaire at two days postpartum were analyzed. An exploratory factor analysis of the JW-DEQ version B revealed four factors: fear, lack of positive anticipation, isolation and riskiness. The JW-DEQ version B exhibited a positive correlation with the HADS anxiety subscale (r = 0.34, p α value derived from the total 33 items was 0.95. This study provides evidence of the factorial, concurrent validity and the internal consistency of the JW-DEQ version B. However, a further study involving participants from different demographic groups will be required.

Associations of Mental and Behavioral Problems among Children Exposed to Intimate Partner Violence Previously and Visits with Their Fathers Who Perpetrated the Violence

Background: Intimate partner violence has long-term and negative effects on the health of mothers and children worldwide. This study aimed to identify the mental and behavioral effects of past exposure to intimate partner violence among children and examine their associations with the children’s visits with their fathers who perpetrated the intimate partner violence. Methods: A cross-sectional study of women who had been abused by their intimate partners and had one or more children aged 4 - 18 years old was conducted from March 2015 to December 2016. Questionnaires were used to collect (1) demographic data about the mothers and children, (2) information about the children’s visits with the mother’s former partner (i.e., father), and (3) psychological data using the Hospital Anxiety and Depression Scale and the Child Behavior Checklist/4 - 18. Results: The average scores and rates of internalizing, externalizing, and total problems among the children who had been exposed to intimate partner violence were: 10.8 (SD = 10.4), 26 (51.0%);9.0 (SD = 9.0), 14 (27.5%);and 26.3 (SD = 21.5), 15 (29.4%), respectively. Children’s visits with fathers who were IPV perpetrators were significantly associated with the internalizing (AOR = 12.6, β = 0.56;p β = 0.48;p Conclusion: Attention should focus on traumatized children exposed to intimate partner violence, and thorough and cautious assessments and decisions regarding visits with their fathers who are IPV perpetrators are essential to safeguard and improve their mental and behavioral health.