Perinatal Anxiety among Women during the COVID-19 Pandemic—A Cross-Sectional Study
Abstract
:1. Introduction
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- Learning about respondents’ opinions on the support received from medical personnel and relatives.
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- Assessment of received social support impact on the perinatal anxiety level.
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- Assessment of perinatal care and education and its impact on experienced perinatal anxiety level.
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- Analysis of the relation between psychological condition and experienced perinatal anxiety level.
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- Assessment of the influence of selected obstetric factors on the experienced perinatal anxiety occurrence.
2. Materials and Methods
2.1. Study Design and Participants
- The State-Trait Anxiety Inventory (STAI) is a tool comprising two scales. The first part of the STAI (x-1) examines the level of anxiety as a current emotional state. It consists of 20 statements, for each of which the respondent chooses one of four possible answers (definitely, probably, probably not, definitely not). The responses to these statements describe the respondent’s feelings while filling out the questionnaire. The second part (x-2) concerns anxiety understood as a personality trait. It also consists of 20 statements that the respondent can answer, using a four-point scale (almost never, sometimes, often, almost always). The responses for this second part provide a picture of how the respondent usually feels [18,19]. The Cronbach’s alpha coefficient for the questionnaire for the studied group was 0.908 (x-1) and 0.869 (x-2), (Supplementary File).
- The Childbirth Anxiety Questionnaire (CAQ): a tool for gaining information on emotions associated with upcoming childbirth. The CAQ is made up of nine statements to which the respondent answers by choosing one of four categories (definitely, probably, probably not, definitely not) to which numerical values are assigned. The higher the score, the greater severity of childbirth anxiety [20]. The Cronbach’s alpha reliability coefficient for the research group was 0.824, (Supplementary File).
- The questionnaire specially prepared for this study takes into consideration the characteristics of the women being researched as well as questions concerning the research topic. The respondents answered on a five-point Likert scale (1—definitely not, 5—definitely yes) on the topics of determinants of childbirth anxiety they felt and healthcare conditions in the time of the SARS-CoV-2 virus pandemic.
2.2. Statistical Analysis
3. Results
“I am worried about the current epidemiological situation and the impossibility of family members being present for the delivery; even more, I am stressed about giving birth by myself.”
“I have brief attacks of hysteria, but they pass quickly.”
“The current epidemic greatly increases my anxiety before giving birth. My husband has promised to be with me for the delivery, our due-date is the end of September. Knowing that having family members at the delivery has still not been restored yet at the hospitals in my region causes additional, senseless anxiety and panic. And to what purpose? I am not afraid of a virus, I am afraid of trauma and post-partum depression caused by having my rights, peace, and dreams taken away. I cannot imagine being alone in such a difficult situation as giving birth to my first child.”
“The long years of fighting infertility have certainly influenced my perception of anxiety and childbirth, because I know that I may not have a second chance, so I am more afraid. And now this epidemic…”
“More than labor and delivery, I am afraid about successfully carrying the pregnancy, due to an earlier miscarriage and long, in my opinion, attempts to have a baby. My desire for a child is so great that I am not interested in the fact that I will feel pain, I am ready for anything, just to give birth successfully, especially in this situation with coronavirus.”
4. Discussion
Strengths and Limitations of the Study
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Participants’ Characteristics | I Trimester | II Trimester | III Trimester | Total | |
---|---|---|---|---|---|
% (n) | % (n) | % (n) | |||
Age | <20 | 2.5 (3) | 0.6 (1) | 2.4 (6) | 1.9 (10) |
20–29 | 78.2 (93) | 64.1 (109) | 61.2 (150) | 65.9 (352) | |
30–39 | 19.3 (23) | 33.5 (57) | 34.3 (84) | 30.7 (164) | |
≥40 | - | 1.8 (3) | 2.0 (5) | 1.5 (8) | |
Residence | urban—province capital | 36.1 (43) | 38.8 (66) | 41.2 (101) | 39.3 (210) |
other cities | 40.3 (48) | 37.6 (64) | 33.5 (82) | 36.3 (194) | |
rural | 23.5 (28) | 23.5 (40) | 25.3 (62) | 24.3 (130) | |
Education | university | 63.9 (76) | 64.2 (109) | 60.0 (147) | 62.2 (332) |
other educational stages | 36.1 (43) | 35.8 (61) | 40.0 (98) | 37.8 (202) | |
Professional activity | currently does not work | 18.5 (22) | 65.9 (112) | 81.2 (199) | 68.2 (364) |
does not work professionally at all | 44.5 (53) | 13.5 (23) | 6.1 (15) | 11.2 (60) | |
(she) works | 37.0 (44) | 20.6 (35) | 12.7 (31) | 20.8 (110) | |
Relationship status | married/informal relationship | 89.1 (106) | 90.0 (153) | 92.7 (227) | 91.0 (486) |
single | 10.9 (13) | 10.0 (17) | 7.3 (18) | 9.0 (48) | |
Self-reported financial standing | good | 73.9 (88) | 74.7 (127) | 73.1 (179) | 73.8 (394) |
bad | 26.1 (31) | 25.3 (43) | 26.9 (66) | 26.2 (140) | |
Having children | no, it’s the first pregnancy | 58.8 (70) | 63.5 (108) | 69.4 (170) | 65.2 (348) |
one child | 26.9 (32) | 28.8 (49) | 23.7 (58) | 26.0 (139) | |
two or more children | 14.3 (17) | 7.7 (13) | 6.9 (17) | 8.8 (47) | |
The person providing care | doctor | 67.2 (80) | 73.5 (125) | 66.9 (164) | 69.1 (369) |
midwife | 5.9 (7) | 1.2 (2) | 0.4 (1) | 1.9 (10) | |
doctor and midwife | 25.2 (30) | 24.1 (41) | 31.8 (78) | 27.9 (149) | |
she was not under the care of a doctor/midwife | 1.7 (2) | 1.2 (2) | 0.8 (2) | 1.1 (6) | |
Participation in Childbirth Classes | yes—face-to-face meeting with the midwife | 30.3 (36) | 18.8 (32) | 31.8 (78) | 27.3 (146) |
yes—video- and teleconferences | 0.8 (1) | 10.0 (17) | 12.3 (30) | 9.0 (48) | |
no, she did not have the opportunity/possibility | 5.9 (7) | 14.1 (24) | 25.7 (63) | 17.6 (94) | |
no, she was not interested | 12.6 (15) | 23.5 (40) | 24.1 (59) | 21.3 (114) | |
has not participated yet but would like to | 50.4 (60) | 33.5 (57) | 6.1 (15) | 24.7 (132) |
Pregnancy Trimester | Childbirth Anxiety | |||||||
Anxiety as a State | Anxiety as a Trait | |||||||
M | SD | M | SD | |||||
I trimester | 40.97 | 8.46 | 40.97 | 8.77 | ||||
II trimester | 41.12 | 9.24 | 42.35 | 8.63 | ||||
III trimester | 42.40 | 8.42 | 42.20 | 8.75 | ||||
Statistic | F = 1.58 p = 0.207 η2 = 0.01 | F = 1.03 p = 0.35 η2 = <0.01 | ||||||
Anxiety Level | Pregnancy Trimester | |||||||
I | II | III | ||||||
% (n) | % (n) | % (n) | ||||||
Low | 42.8 (51) | 37 (63) | 42 (103) | |||||
Elevated | 11.8 (14) | 16.5 (28) | 15.5 (38) | |||||
High | 15.1 (18) | 25.2 (30) | 14.7 (36) | |||||
Very High | 30.3 (36) | 41.20 (49) | 27.8 (68) | |||||
Statistic | Chi2 = 2.6868 p = 0.846 C = 0.07 | |||||||
Pregnancy in the current epidemiological situation contributes to increased feelings of anxiety | I | II | III | |||||
% (n) | % (n) | %(n) | ||||||
Yes | 57.2 (68) | 56.5 (96) | 60 (147) | |||||
No Opinion | 11.8 (14) | 13.5 (23) | 17.1 (42) | |||||
No | 31.1 (37) | 30.0 (51) | 22.9 (56) | |||||
Statistic | Chi2 = 43.5963 p = 0.008 C = 0.2747 | |||||||
Completion of the pregnancy in accord with prior ideas/plans would lessen feelings of anxiety. | Opinion | |||||||
Yes | No Opinion | No | ||||||
Average Rank | Me | Average Rank | Me | Average Rank | Me | |||
Childbirth Anxiety | 351.05 | 15.00 | 246.56 | 14.00 | 265.72 | 18.00 | ||
Statistic | p = 0.004 |
Source of Support/Factors | Pregnancy Trimester | Yes | No Opinion/ Not Applicable | No | Statistic |
---|---|---|---|---|---|
% (n) | % (n) | % (n) | |||
In the current epidemiological situation, the support of the doctor in charge of the pregnancy was appropriate | I | 76.5 (91) | 16.8 (20) | 6.7 (8) | Chi2 = 10.2185 |
II | 79.4 (135) | 7.6 (13) | 12.9 (22) | p = 0.036 | |
III | 75.5 (185) | 9.8 (24) | 14.7 (36) | C = 0.1370 | |
In the current epidemiological situation, the support of the midwife providing prenatal education was appropriate | I | 42.0 (50) | 52.9 (63) | 5.0 (6) | Chi2 = 28.9580 |
II | 31.2 (53) | 52.9 (90) | 15.8 (27) | p = 7.972 | |
III | 42.4 (104) | 34.7 (85) | 22.8 (56) | C = 0.2268 | |
The support of loved ones (partner, family, friends) is important | I | 95.8 (114) | 3.4 (4) | 0.8 (1) | Chi2 = 11.0432 |
II | 100 (170) | - | - | p = 0.026 | |
III | 99.2 (243) | 0.8 (2) | - | C = 0.1423 | |
I am receiving sufficient support from my loved ones | I | 91.6 (109) | 3.4 (4) | 5.0 (6) | Chi2 = 1.5008 |
II | 90.6 (154) | 2.9 (5) | 6.5 (11) | p = 0.826 | |
III | 89.4 (219) | 2.4 (6) | 8.2 (20) | C = 0.0529 | |
My marital/partnership relations have an influence on the level of childbirth anxiety | I | 86.5 (103) | 7.6 (9) | 5.9 (7) | Chi2 = 7.1569 |
II | 91.8 (156) | 4.1 (7) | 4.1 (7) | p = 0.127 | |
III | 93.5 (229) | 2.0 (5) | 4.5 (11) | C = 0.1150 | |
The presence of a companion during childbirth helps to lessen perinatal anxiety | I | 77.3 (92) | 13.4 (16) | 9.2 (12) | Chi2 = 10.0701 |
II | 78.2 (133) | 18.8 (32) | 3.0 (5) | p = 0.089 | |
III | 78.8 (193) | 13.9 (34) | 7.3 (18) | C = 0.1360 | |
Birthing school/prenatal education prepares you for childbirth physically | I | 61.4 (73) | 25.2 (30) | 13.4 (16) | Chi2 = 16.5734 |
II | 56.5 (96) | 33.5 (57) | 10.0 (17) | p = 0.002 | |
III | 47.3 (116) | 29.4 (72) | 23.3 (57) | C = 0.1734 | |
Birthing school/prenatal education prepares you for childbirth psychologically | I | 71.4 (85) | 21.0 (25) | 7.5 (9) | Chi2 = 2.7928 |
II | 72.4 (123) | 22.9 (39) | 4.7 (8) | p = 0.593 | |
III | 69.3 (170) | 21.6 (53) | 8.9 (22) | C= 0.0721 | |
The subject of childbirth anxiety was brought up during meetings with the midwife/in birthing school | I | 33.6 (40) | 55.5 (66) | 10.9 (13) | Chi2 = 11.9339 |
II | 34.7 (59) | 58.2 (99) | 7.1 (12) | p = 0.017 | |
III | 45.7 (112) | 42.9 (105) | 11.5 (28) | C = 0.1478 | |
Birthing school/prenatal education helps for coping with perinatal anxiety | I | 55.5 (66) | 32.8 (39) | 11.8 (14) | Chi2 = 0.7100 |
II | 57.0 (97) | 34.1 (58) | 8.9 (15) | p = 0.950 | |
III | 57.9 (140) | 33.1 (81) | 9.8 (24) | C = 0.0364 | |
The subject of SARS-CoV-2 (coronavirus) was brought up during meetings/teleconferences with the family midwife or in classes at the birthing school | I | 16.8 (20) | 77.3 (92) | 9.36 (7) | Chi2 = 31.9594 |
II | 17.6 (30) | 75.9 (129) | 13.37 (11) | p = 0.001 | |
III | 36.7 (90) | 53.5 (131) | 19.27 (24) | C = 0.2376 | |
The current epidemiological situation was discussed during meetings/video conferences with the family midwife or in classes at the birthing school | I | 17.6 (21) | 78.2 (98) | 1.7 (5) | Ch2 = 33.8456 |
II | 18.2 (31) | 75.3 (128) | 1.8 (11) | p < 0.001 | |
III | 38.8 (95) | 53.1 (130) | 4.1 (20) | C = 0.2441 | |
Perinatal care has an influence on feelings of childbirth anxiety | I | 73.1 (87) | 21.0 (25) | 5.8 (7) | Chi2 = 10.4824 |
II | 78.8 (134) | 18.8 (32) | 2.4 (4) | p = 0.033 | |
III | 79.2 (194) | 12.7 (31) | 8.1 (20) | C = 0.1387 | |
Knowing about the standards of perinatal care helps in coping with anxiety | I | 58.8 (70) | 31.1 (37) | 10.1 (12) | Chi2 = 18.2418 |
II | 75.2 (128) | 15.9 (27) | 8.9 (15) | p = 0.001 | |
III | 79.2 (194) | 13.1 (32) | 7.7 (19) | C = 0.1817 | |
Concluding the pregnancy by means of Cesarean section would lessen anxiety | I | 31.1 (37) | 14.3 (17) | 54.6 (65) | Chi2 = 5.0353 |
II | 26.4 (45) | 22.4 (38) | 51.2 (87) | p = 0.283 | |
III | 23.3 (57) | 19.2 (47) | 57.5 (141) | C = 0.0966 |
Sources of Support | ||||||
Psychological Condition | Loved Ones | Attending Physician | Family Midwife Providing Prenatal Education | |||
Average Rank | Me | Average Rank | Me | Average Rank | Me | |
Bad | 208.04 | 4.00 | 228.13 | 4.00 | 226.22 | 3.00 |
Good | 283.64 | 5.00 | 278.19 | 4.00 | 278.70 | 3.00 |
Statistic | Z = −5.16 | p = 0.001 | Z = −3.27 | p = 0.001 | Z = −3.40 | p = 0.001 |
Physical Condition | Loved Ones | Attending Physician | Family midwife providing prenatal education | |||
Average Rank | Me | Average Rank | Me | Average Rank | Me | |
Bad | 261.43 | 4.00 | 249.70 | 4.00 | 241.72 | 3.00 |
Good | 272.42 | 5.00 | 281.92 | 4.00 | 288.38 | 3.00 |
Statistic | Z = −0.91 | p = 0.363 | Z = −2.56 | p = 0.011 | Z = −3.67 | p < 0.001 |
Factors Affecting Childbirth Anxiety | ||||||
Manner of pregnancy conclusion | Perinatal care and Birthing school | Pregnancy in the current epidemiological situation contributes to increased feelings of anxiety | Concluding the pregnancy by meansof Cesarean section would lessen anxiety | |||
M | SD | M | SD | M | SD | |
Not Applicable | 22.69 | 3.50 | 3.65 | 1.20 | 2.48 | 1.31 |
Delivery without Complications | 22.15 | 4.24 | 3.17 | 1.37 | 2.01 | 1.21 |
Delivery with Complications | 22.25 | 3.96 | 3.50 | 1.33 | 3.12 | 1.48 |
Statistic | F = 1.09 | p = 0.336 | F = 5.34 | p = 0.005 | F = 19.95 | p < 0.001 |
Participation in Childbirth Classes | Perinatal care and Birthing school | Pregnancy in the current epidemiological situation contributes to increased feelings of anxiety | Concluding the pregnancy by means of Cesarean section would lessen anxiety | |||
M | SD | M | SD | M | SD | |
Yes | 24.13 | 3.76 | 3.58 | 1.25 | 2.46 | 1.39 |
No | 21.60 | 3.37 | 3.49 | 1.29 | 2.58 | 1.38 |
Statistic | T = 7.98 | p < 0.001 | T = 0.80 | p = 0.426 | T = −0.95 | p = 0.341 |
Psychological Condition | Childbirth Anxiety | |||
Anxiety as a State | Anxiety as a Trait | |||
M | SD | M | SD | |
Bad | 48.75 | 7.38 | 49.23 | 6.46 |
Good | 39.75 | 8.03 | 40.00 | 8.20 |
Statistic | T = 10.80 | p < 0.001 | T = 12.72 | p < 0.001 |
Physical Condition | Anxiety as a State | Anxiety as a Trait | ||
M | SD | M | SD | |
Bad | 44.13 | 8.57 | 44.95 | 8.30 |
Good | 39.68 | 8.32 | 39.55 | 8.31 |
Statistic | T = 6.05 | p < 0.001 | T = 7.48 | p < 0.001 |
The course of the previous birth | Anxiety as a State | ANXIETY AS A Trait | ||
M | SD | M | SD | |
Not Applicable | 41.57 | 8.42 | 42.12 | 8.67 |
Delivery without Complications | 41.79 | 8.62 | 41.76 | 8.78 |
Delivery with Complications | 41.84 | 9.52 | 41.77 | 8.86 |
Statistic | F = 0.05 | p = 0.948 | F = 0.10 | p = 0.901 |
Participation in Childbirth Classes | Anxiety as a State | Anxiety as a Trait | ||
M | SD | M | SD | |
Yes | 41.21 | 9.04 | 40.80 | 8.77 |
No | 41.94 | 8.52 | 42.64 | 8.63 |
Statistic | T = −0.92 | p = 0.356 | T = −2.35 | p = 0.019 |
Factors | Anxiety as a State | Anxiety as a Trait | |
---|---|---|---|
Support during the current epidemiological situation from the OB-GYN treating the pregnancy | r | −0.15 | −0.17 |
p | <0.001 | <0.001 | |
Support during the current epidemiological situation from a family midwife providing prenatal education | r | −0.13 | −0.18 |
p | 0.002 | <0.001 | |
Maternal experience | rho | 0.01 | −0.02 |
p | 0.882 | 0.628 | |
Number of pregnancies | rho | 0.02 | −0.01 |
p | 0.653 | 0.860 |
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Iwanowicz-Palus, G.; Mróz, M.; Korda, A.; Marcewicz, A.; Palus, A. Perinatal Anxiety among Women during the COVID-19 Pandemic—A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 2603. https://doi.org/10.3390/ijerph19052603
Iwanowicz-Palus G, Mróz M, Korda A, Marcewicz A, Palus A. Perinatal Anxiety among Women during the COVID-19 Pandemic—A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2022; 19(5):2603. https://doi.org/10.3390/ijerph19052603
Chicago/Turabian StyleIwanowicz-Palus, Grażyna, Mariola Mróz, Aleksandra Korda, Agnieszka Marcewicz, and Agnieszka Palus. 2022. "Perinatal Anxiety among Women during the COVID-19 Pandemic—A Cross-Sectional Study" International Journal of Environmental Research and Public Health 19, no. 5: 2603. https://doi.org/10.3390/ijerph19052603
APA StyleIwanowicz-Palus, G., Mróz, M., Korda, A., Marcewicz, A., & Palus, A. (2022). Perinatal Anxiety among Women during the COVID-19 Pandemic—A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 19(5), 2603. https://doi.org/10.3390/ijerph19052603