Rationale: The birth environment effects on childbirth experience and feelings of security of birthing women. Fear of Childbirth (FOB) is experienced by 6-10% of women in Finland and FOB predicts postpartum depression. Real or artificial views of nature have several positive health effects including reduction of anxiety and stress. Feasible and cost-effective nature-based intervention is being studied in this pilot RCT. Objectives: To develop a virtual nature-based intervention for the delivery ward and to assess its feasibility and effectiveness. The study assesses how the nature-based intervention carried out during the first stage of labour affects the anxiety, fear, stress, pain and childbirth experience of birthing women. The aim is to provide evidence-based information on the feasibility and effectiveness of this intervention. Methods: Sixty women will be randomized into two groups: Nature-based intervention group and control group. All participants will have assessments during first stage of labour in nature-based intervention group before and after intervention and in control group at the same time without intervention. In both groups also 2-6 hours after childbirth, 2 days after childbirth and 2 weeks after childbirth.
During the piloting and feasibility assessment phase of intervention, the nature-based intervention is tested and its feasibility and preliminary effectiveness on the anxiety, fear, stress, pain and childbirth experience is assessed. Phase II consists of a pilot RCT (Randomized Control Trial) study and a qualitative interview study. The nature-based intervention includes videos filmed in the nature of Northern Finland and takes place during 1st stage of labour before the need for medical pain relief. The pilot phase test group (N=30) will receive a nature-based intervention in addition to standard care during childbirth and the control group (N=30) receives standard care treatment. The study includes parturients (weeks of pregnancy 37+0-41+6) entering delivery ward during active labour. Before childbirth the participants in the study are measured for anxiety, stress, fear of childbirth and pain, and feeling of safety. After childbirth, the childbirth experience is assessed in the deliveryward and before discharge in postnatal ward. Before discharge, postpartum experience with anxiety, fear of childbirth and depression is also measured. During the pilot phase at two weeks, childbirth experience, anxiety and depression are assessed. Data related to childbirth and mental health diagnoses is also collected. The data is analysed using statistical methods. In the pilot phase, the participants in the intervention group (N=5-10) will be interviewed two weeks after childbirth. Thematic interview about the experiences of nature-based interventions of midwives in the delivery room (N=5-10) will also take place. Interviews are recorded and the materials are analysed by inductive content analysis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
60
Virtual nature-based intervention is video with Finnish naturepictures and naturesounds shown from a 75" vertical screen monitor
Oulu University Hospital
Oulu, Finland
RECRUITINGAnxiety measured with STAI-Y1, change is being assessed
The STAI meter is a two-part adult anxiety meter developed by Charles D. Spielberg and his research team (1983). It separates situation related anxiety (STATE-A = Y1) from character related tendency towards anxiety (TRAIT-A). In this study, the most used version of the STAI meter and only it's STATE-A section is utilized. Woman evaluates own current anxiety on a four-step scale with twenty questions. The respondents choose from the following options at each question: 1 = no anxiety at all, 2 = slight anxiety, 3 = some anxiety 4 = very much anxiety.
Time frame: 1) Pre-intervention 2) Two days after childbirth 3) Two weeks after childbirth
1) Fear 2) Pain and 3) Feeling of Security with VAS, change is being assessed
VAS (Visual Analogy Scale). The VAS scale allows women to evaluate the intensity of three outcomes (three separate scales); 1) fear 2) pain and 3) feel of security on a 10cm long scale that starts at zero meaning 1) no pain 2) no fear 3) feeling of security at all and ends at 10 representing 1) the worst possible pain 2) the worst possible fear 3) the worst possible feeling of unsecurity.
Time frame: Pre-intervention and immediately after the intervention
Fear of Childbirth with W-DEQ version Fear of Childbirth W-DEQ version Fear of Childbirth with W-DEQ version B
W-DEQ version B allows women to evaluate experiences around fear of childbirth after the birth. It is currently the most widely used to measure different aspects related to the fear of childbirth. It includes 33 Likert-scale questions (0-5).
Time frame: Two days after childbirth
Birth Experience with NRS, change is being assessed
The NRS (Numeric rating scale) allows women to evaluate the birth experience from 1 to 10 immediately after birth and two days later. One means a very negative birth experience and 10 means a very positive birth experience.
Time frame: 1) Two - six hours after childbirth 2) two days after childbirth
Birth Experience with DSS, change is being assessed
The DSS (Delivery Satisfaction Scale) allows women to evaluate the birth experience with 8 questions with a 1-5 scale, 1 meaning very much and 5 not at all
Time frame: 1) Two - six hours after childbirth 2) two days after childbirth 3) two weeks after childbirth
Maternal Depression with EPDS, change is being assessed
EPDS (Edinburg Postnatal Depression Scale) allows women to estimate symptoms of post-natal depression. Each answer is given a score of 0 to 3 . The maximum score is 30.
Time frame: 1) two days after childbirth 2) two weeks after childbirth
Stress with physiological measures: Heart rate, change is being assessed
Heart rate (HR, beats per minute, BPM)
Time frame: Pre-intervention and immediately after the intervention
Stress with physiological measures: Heart rate variability, change is being assessed
Heart rate variability (HRV, milliseconds, ms)
Time frame: Pre-intervention and immediately after the intervention
Stress with physiological measures: Blood pressure, change is being assessed
Blood pressure: systolic (SBP, mmHg) and diastolic (DBP, mmHg)
Time frame: Pre-intervention and immediately after the intervention
Stress with physiological measures: Blood pressure variation, change is being assessed
Blood pressure variation (BP variation, mmHg)
Time frame: Pre-intervention and immediately after the intervention
Stress with physiological measures: Respiration rate, change is being assessed
Respiration rate (RR, breaths per minute BPM)
Time frame: Pre-intervention and immediately after the intervention
Stress with physiological measures: Baroreflex sensitivity, change is being assessed
Baroreflex sensitivity (BRS, ms/mmHg)
Time frame: Pre-intervention and immediately after the intervention
Stress with serum cortisol, change is being assessed
Serum cortisol (nmol/l)
Time frame: Pre-intervention and immediately after the intervention
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