Souto Sandra Patrícia Arantes do, Silva Rosa Carla Gomes da, Prata Ana Paula, Guerra Maria João, Couto Cristina, Albuquerque Rosemeire Sartori de
Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.
Maternity unit, Hospital Center Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal.
JBI Evid Synth. 2022 Dec 1;20(12):2867-2935. doi: 10.11124/JBIES-21-00382.
The objective of this review was to map and analyze midwives' interventions for reducing fear of childbirth in pregnant women.
Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy. Over the past few decades, there has been growing research interest in interventions for reducing fear of childbirth in pregnant women. One of the challenges in midwifery care is to provide an appropriate model of care for pregnant women with fear of childbirth. Further research efforts are needed to identify midwives' interventions for reducing fear of childbirth in pregnant women and to examine their characteristics.
This scoping review considered studies that included midwives' interventions for reducing fear of childbirth in pregnant women. Specifically, interventions were led and/or implemented by midwives during the antenatal period, and integrating all possible midwifery practice settings. Quantitative, qualitative, and mixed methods studies were included. This review also considered systematic reviews, text and opinion papers, and conference abstracts.
The JBI methodology for conducting scoping reviews was used. Published and unpublished literature in English, Portuguese, and Spanish from January 1981 to October 2020 was included. MEDLINE (PubMed), CINAHL Complete, APA PsycINFO, Scopus, Embase, Web of Science, SciELO, MedicLatina, Academic Search Complete, ERIC, Psychology and Behavioral Sciences Collection, and the Cochrane Library databases were searched. Searches for gray literature were also undertaken on the Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, British Library EThOS, OvidSP Resource Center, Banco de Teses da CAPES, and OpenGrey. A three-step search strategy was followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist was used. Two independent reviewers extracted the data using a data extraction tool developed specifically for this scoping review.
A total of 3704 articles were identified and screened, of which 34 articles were included. The majority of studies had been published in the past 10 years (88%) in Scandinavian countries or Australia (79%). Several midwives' antenatal interventions were found, such as midwife-led team models of care. Midwives played a facilitator role that varied across the included studies. In 20 studies (59%), midwives led and implemented the interventions alone ( n = 13; 38%) or with the participation of other health professionals ( n = 7; 21%). In the remaining 14 studies (41%), midwives were part of a multidisciplinary team that included different health professionals (mainly obstetricians and psychologists) who had been involved in delivering interventions alongside midwives or with minor participation from midwives. Counseling ( n = 12; 35%) and psychoeducation ( n = 8; 24%) were the most common midwife interventions for reducing fear of childbirth in pregnant women.
Midwives working across their full scope of practice play a pivotal role in reducing fear of childbirth, which may explain the variety of midwives' antenatal interventions. Reducing fear of childbirth in pregnant women and promoting normal childbirth as a positive experience are key features of midwives' interventions, which should include women's empowerment measures. Evidence-based midwife-led intervention programs for pregnant women with fear of childbirth should be designed and tested to improve clinical practice as well as women's reproductive outcomes and perinatal experiences.
本综述的目的是梳理和分析助产士为减轻孕妇分娩恐惧所采取的干预措施。
分娩恐惧是一种在孕期前后对女性健康和幸福感产生负面影响的现象。在过去几十年里，针对减轻孕妇分娩恐惧的干预措施的研究兴趣日益浓厚。助产护理面临的挑战之一是为有分娩恐惧的孕妇提供合适的护理模式。需要进一步的研究来确定助产士减轻孕妇分娩恐惧的干预措施，并审视其特点。
本范围综述纳入了包含助产士减轻孕妇分娩恐惧干预措施的研究。具体而言，干预措施由助产士在产前阶段主导和/或实施，并涵盖所有可能的助产实践环境。纳入了定量研究、定性研究和混合方法研究。本综述还纳入了系统评价、文本和观点论文以及会议摘要。
采用JBI循证卫生保健中心开展范围综述的方法。纳入1981年1月至2020年10月期间以英文、葡萄牙文和西班牙文发表的已发表和未发表文献。检索了MEDLINE（PubMed）、CINAHL Complete、APA PsycINFO、Scopus、Embase、Web of Science、SciELO、MedicLatina、Academic Search Complete、ERIC、心理学与行为科学数据库以及Cochrane图书馆数据库。还在葡萄牙开放获取科学知识库、ProQuest学位论文数据库、大英图书馆EThOS、OvidSP资源中心、巴西高等教育人员素质提升协调办公室论文库和OpenGrey上检索了灰色文献。遵循三步检索策略，并使用系统评价和Meta分析的首选报告项目扩展版范围综述清单。两名独立评审员使用专门为此范围综述开发的数据提取工具提取数据。
共识别并筛选出3704篇文章，其中34篇被纳入。大多数研究在过去10年发表（88%），发表国家主要是斯堪的纳维亚国家或澳大利亚（79%）。发现了几种助产士的产前干预措施，例如助产士主导的团队护理模式。助产士在纳入的研究中发挥的促进作用各不相同。在20项研究（59%）中，助产士独自主导并实施干预措施（n = 13；38%）或在其他卫生专业人员参与下实施（n = 7；21%）。在其余14项研究（41%）中，助产士是多学科团队的一员，该团队包括不同的卫生专业人员（主要是产科医生和心理学家），他们与助产士一起参与实施干预措施，或助产士参与较少。咨询（n = 12；35%）和心理教育（n = 8；24%）是助产士减轻孕妇分娩恐惧最常用的干预措施。
全面开展工作的助产士在减轻分娩恐惧方面发挥着关键作用，这或许可以解释助产士产前干预措施的多样性。减轻孕妇分娩恐惧并促进将正常分娩视为积极体验是助产士干预措施的关键特征，其中应包括增强女性权能的措施。应设计并测试以证据为基础的由助产士主导的针对有分娩恐惧孕妇的干预项目，以改善临床实践以及女性的生殖结局和围产期体验。
