Influence of child birthing audiovisuals on anxiety and obstetric outcomes of first time mothers in Ibadan: a randomized controlled trial

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During antenatal visits, expectant mothers are routinely given information to educate them on what to expect during labour and delivery, in an effort to allay their fears. However most of this information is delivered verbally or with the aid of diagrammatic illustrations in an abstract manner. Previous studies in the United States of America (USA) have demonstrated the important role that online birth education plays on reducing anxiety. For example about 72 percent of women who were pregnant for the first time, and 34 percent of women who had been pregnant once before indicated their preference for audio-visual assistance prior to their delivery, in order to gain useful understanding of the process ahead. However, another study reported a different outcome, as 32 percent of first-time mothers felt more anxious after watching audiovisual displays about the birthing process. This may be due to the absence of quality control and screening of the contents in this study, thereby leading to a counterproductive and biased outcome of increasing anxiety, instead of diminishing it. The possible adverse effects of anxiety especially at such critical times in the life of an expectant mother and the unborn baby are immense, but unfortunately, ways to reduce these levels are yet to be explored. There are no studies among African women (including Nigeria) to show the effect of controlled use of audiovisuals on anxiety levels among mothers who have not experienced the childbirthing process. This study therefore aims to determine the effect of child birthing audiovisuals in the reduction of anxiety levels in first time mothers. The general objective is to determine the influence of child birthing audiovisual on anxiety levels among pregnant women before, during and after childbirth, pain perception during labour and obstetric outcomes. The specific objectives are: To determine the influence of audiovisuals of childbirth on anxiety levels among pregnant women before, during and after childbirth. And To determine the influence of antenatal audiovisuals on obstetric outcome for women in both arms of the study. Material and Methods: The study was a randomized controlled trial among booked antenatal patients at the University College Hospital, Ibadan, Oyo State, Nigeria. Prospective mothers who met the criteria below were informed and recruited into the study. The eligibility criteria included: 1. Primigravid/ nulliparous pregnant women 2. Anticipated vaginal delivery 3. Absence of medical disorders (hypertension, Diabetes Mellitus) 4. Singleton foetus in the current pregnancy 5. 28 -30 weeks gestation The study was conducted at the University College Hospital, Ibadan (UCH), in south-west Nigeria from Octobert 2012 to June 2013. This health facility is an 850-bed hospital with an annual delivery rate of between 1500 and 2000. An average of 120 pregnant women are seen per week during antenatal care (ANC) clinic. At each antenatal clinic (ANC), the routine care involves registration, vital signs measurement and group health talk before consultation by doctors. The labour ward has an admission room, the first stage, delivery suite and theatre. Intervention: The intervention was a five minutes documentary film on the events that occur during the second stage of labour. This was shown to those in the experimental group after recruitment and assessment of baseline anxiety levels. Questions and clarifications were made during the course of the session to dispel misconceptions and improve knowledge among respondents in the experimental group. Outcomes: The primary outcome was a significant change in level of anxiety in the treatment/intervention arm compared to the controls. The secondary outcome was a significant change in obstetric outcomes for those in the treatment arm compared to those in the control arm.

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