Corresponding Author: Andi
Hafsa
Email: [email protected]
INTRODUCTION
Becoming a mother is a destiny
inherent in a woman, especially when experiencing pregnancy, giving birth, and
having children, which add happiness to family life (Diana
Dayaningsih, 2016). The presence of a child is
often awaited, although the process of presenting it is sometimes not easy for
some couples (Meiliasari
& Danuatmaja, 2004). Approaching delivery, in many
cases, the final trimester brings increasingly complex and increasing
psychological changes as a result of the preparation process for birth (National, 2009). This is a risk that mothers
must face during childbirth, whether it occurs spontaneously, because of
assistance, or because they are forced to give birth due to special conditions (Manuaba, 1998). The various things that mothers
face during pregnancy and childbirth will undoubtedly increase when these
things are experienced for the first time.
The first pregnancy, or primigravida (Pieter, 2018), is often a burden in itself for
the mother because increasing the weight of the womb and increasing physical
discomfort can put an additional burden on the pregnant mother, which in turn
can disrupt her psychological condition. This can cause anxiety,
especially before childbirth (Kartono,
1986), especially for primigravida
mothers who have no experience regarding the birth process. For example,
anxiety about experiencing pain during contractions before birth and pain
during childbirth, anxiety when seeing blood during delivery, fear that the baby
will be deformed, and other fears.
Some primigravida mothers generally also experience fear that their
genitals will suffer severe tearing due to an episiotomy (torn to facilitate
the process of giving birth to the baby) and fear of complications during
childbirth (Legawati,
2019); Aprilia, 2014; (Kurniawati
& Wahyuni, 2014). The feeling of anxiety felt
by mothers who think about the birth process and the condition of the baby to
be born (Arief, 2008)
is said to be (Stuart,
2006) a form of abstract and
widespread worry related to feelings of uncertainty and feelings of
helplessness. The level of anxiety before childbirth in primigravida varies
greatly.
According to research (Saputra
& Mubin, 2013), the level of anxiety in
primigravida mothers in the high category can reach 63.3%, almost the same as
research (Mukhadiono
et al., 2015) which recorded high anxiety in
primigravida mothers in the third trimester when approaching delivery. It can
reach a percentage of 60.7%. Although (Maki et al.,
2018) in their research stated that
anxiety in primigravida mothers is, on average, in the moderate category with a
percentage of 43.8% to 59% of research (Aniroh &
Fatimah, 2019). (Abidah et
al., 2021) their research illustrates
that 47.5% of pregnant women tend to have severe levels of anxiety.
Anxiety in primigravida mothers was also seen in 8 primigravidas
interviewed by researchers on April 26, 2023, to April 29, 2023, at the
Bakunase Community Health Center, Kupang City. Five of the eight women
interviewed revealed that they experienced an increased heart rate when
imagining the birth process they would experience. In addition, they also noted
a decrease in appetite when seeing babies with congenital disabilities, which
resulted in anxiety behaviors such as avoiding negative stories about the birth
experience. Some of them feel physical tension, such as dizziness, headaches,
and joint pain, when they think about the approaching time of delivery. Apart
from that, these primigravida mothers also showed signs such as often
forgetting or losing focus when thinking about the closeness of delivery. They
expressed fear related to the possibility of the baby being born imperfectly or
experiencing health problems, concern about potential risks during the birthing
process, and horror at the sight of blood. They feel anxiety, tension, and
panic due to their lack of experience and lack of understanding about the
birthing process, and they have no idea about what actions to take during
labor. Fear also includes losing control, such as unconsciously making strange
sounds, whining, getting angry at the companion (husband), and feeling anxious
and tense about meeting their baby. In addition, they also expressed feelings
of guilt or sin towards their mothers, which further increased their fear of
death.
In previous research, it was stated that more than 74 pregnant women
studied did not receive support from their husbands and, therefore, rarely had
their pregnancies checked (Grace et
al., 2022). The research also showed
that as many as 161 pregnant women had insufficient knowledge and, therefore,
did not know the importance of pregnancy checks until just before delivery.
The description of the symptoms shows that anxiety in primigravida mothers
during the birth process can appear quickly, even though the impact is
certainly not beneficial for them. Negative impacts may arise, including the
length of the labor process, less effective contractions, and difficulty
opening (Sondakh,
2013). Considering these
conditions, anxiety when facing childbirth must be reduced so that primigravida
mothers can give birth smoothly and do not experience trauma.
Several sources state that anxiety in primigravida mothers can be reduced
and minimized when there is support from the family, especially the husband (Bobak et
al., 2005) ; (Legawati,
2019) ; (Romalasari
& Astuti, 2020). It was stated (Maharani
& Fakhrurrozi, 2014) that when a husband gives
encouragement and attention to his wife, it makes the wife mentally stronger in
dealing with problems that arise during pregnancy and childbirth. It was
emphasized (Romalasari
& Astuti, 2020) that a husband's support for
his wife can positively influence the mother's physical readiness during
childbirth.
Husband's support as part of social support is the understanding or
experience that a person receives love and attention from other people and
feels respected and appreciated (Taylor,
2011) ; (Legawati,
2019). It was stated (Diani &
Susilawati, 2013) research that there were
primigravida mothers who received less than optimal support from their husbands
and tended to feel more anxious. The same research also found (Etty et al.,
2020) that a lack of husband's
support makes primigravida mothers feel anxious, while mothers who receive a
husband's support tend to be less anxious when facing childbirth.
Apart from social support, the knowledge that primigravida mothers have
about childbirth also influences their level of anxiety before giving birth (Nolan, 2010)
; (Naha &
Handayani, 2018) ; (Lendy et
al., 2018) ; (Sari, 2017). Knowledge about the birth
process is an internal factor of the individual himself. Therefore, a lack of
preparation and understanding, especially for pregnant women, can affect their
thoughts and feelings when facing the birth process, which, in the end, can
cause anxiety (Nolan, 2010).
Knowledge and readiness for childbirth refers to the understanding and
preparation made by pregnant women in welcoming the birth of a child,
especially in the third trimester of pregnancy. This includes understanding
risks to the mother and fetus, psychological and physiological changes,
knowledge of danger signs and how to cope, feelings related to the birth
process and baby growth, understanding signs of labor, responses to birth, and
family-focused care (Naha &
Handayani, 2018). A pregnant woman's
understanding of the birthing process is crucial, especially when the pregnant
woman experiences disturbing thoughts in response to anxiety related to various
conditions during pregnancy. On the other hand, excessive anxiety can cause
fear in mothers who are about to give birth and can have an impact on the
smoothness of the birth process (Bobak et
al., 2005). On this side, primigravida
pregnant women who are about to give birth look for people or their closest
family to provide advice, direction, and care (Bobak et
al., 2005).
Previous research explains that primigravida pregnant women with sufficient
knowledge tend to be less anxious than those without knowledge and preparation
for childbirth (Lendy et
al., 2018). Furthermore, (Sari, 2017) states that the understanding
possessed by pregnant women about the childbirth process can help reduce their
anxiety before delivery. Earlier studies clarify that pregnant women with
insights and understanding of the birthing process are more likely to increase
their literacy levels related to pregnancy (Sari, 2017). They actively seek helpful
information about maternal health and even child care, leading to a reduction
in anxiety levels. According to (Notoatmodjo,
2022), this can impact knowledge,
thereby improving the knowledge of these pregnant women.
Based on the
above background, the objective of this research is to investigate the
relationship between husbands' support and knowledge regarding childbirth and
the level of anxiety experienced by primigravida during the childbirth process.
The benefits of this study involve a positive contribution to the understanding
of healthcare practitioners, particularly in designing more effective
interventions to address anxiety in primigravida. The research findings can
provide an empirical foundation for healthcare providers to develop more
focused husband support programs and education, thereby enhancing the mental
and emotional well-being of pregnant women.
METHOD
This research uses quantitative methods. There are two
variables analyzed, namely one dependent variable, namely anxiety about facing
childbirth in primigravida, and two independent variables, namely the husband's
support and knowledge about the birth process.The population that is the focus
of this research consists of all pregnant women, totaling 297 people who
visited in March-April 2023 and were registered as patients at the Bakunase
Health Center, Kupang City. The non-probability sampling technique was
purposive sampling with the criteria of being primigravida (pregnant for the
first time) with a gestational age between 28-42 weeks and routinely carrying
out pregnancy checks. The number of participants willing to contribute to this
research was 102. The instruments used by the researchers were a
questionnaire with a scale of anxiety facing primigravida childbirth, a scale
of husband's support, and a test of knowledge about childbirth. The three
scales were prepared by the researcher using the Likert scaling model, which
uses five alternative answer choices, and the Guttman scale model, which uses
right and wrong answer choices. Researchers compiled the Anxiety Scale based on the
anxiety response identified by (Stuart, 2006), which involves four aspects, namely physiological,
behavioral, cognitive, and affective. Meanwhile, the Husband's Support Scale
was prepared by researchers by referring to aspects of social support described
by (Taylor, 2011). This scale includes three dimensions, namely
instrumental support, information support, and emotional support. The knowledge
test used in this research referred to the cognitive domain defined by Bloom,
which consists of knowledge, comprehension, application, analysis, synthesis,
and evaluation. However, to be more relevant, only two cognitive domains are
used: knowledge and comprehension. Data analysis was carried out using Multiple Linear
Regression Analysis to prove the research hypothesis.
RESULTS AND DISCUSSION
Description of Research Data
Data from the Anxiety Scale for Facing Childbirth, the
Husband's Support Scale, and the Knowledge Test about Childbirth were processed
to obtain empirical scores and calculate hypothetical scores. Detailed data
scores for these three variables can be found in Table 1 below:
Table 1. Research Data Mapping Using Hypothetical Data
and Empirical Data
|
Variable
|
Hypothetical Data
|
Empirical Data
|
|
Mean
|
elementary school
|
Mean
|
elementary school
|
|
Anxiety Facing Childbirth
|
84
|
28
|
66.66
|
36,696
|
|
Husband's Support
|
56
|
67
|
68.29
|
23,298
|
|
Knowledge About Childbirth
|
20
|
6.67
|
28.67
|
8,597
|
Based on the table above, the data shows that the anxiety variable facing
childbirth has a hypothetical minimum score of 0 and a maximum score of 168.
The hypothetical mean is 84, with a standard deviation of 28. Based on
empirical data, the minimum score is three, and the maximum score is 150. The
empirical mean is 66.66, with a standard deviation of 36.696.
The results of the following calculation show
that the husband's support variable has a minimum score of 0 and a maximum
score of 112. The hypothetical mean
is 56, with a standard deviation of 18.67. Based on empirical data, the minimum
score was 12, and maximum scores were 111. The empirical mean was 68.29, with a
standard deviation of 23.298.
Furthermore, the calculation results show that the
knowledge variable has a minimum score of 0 and a maximum score of 40. The
hypothetical mean is 20, with a standard deviation of 6.67. Based on empirical
data, the minimum score was three, and the maximum score was 40. The empirical
mean was 28.67, with a standard deviation of 8.597.
Categorization
The results of the
Anxiety Scale Facing Childbirth categorization indicated that participants were
in the high category at 12% (12 people), medium at 46.1% (47 people), and low
at 42.2% (43 people), meaning that the majority of participants felt anxiety about
facing labor at a moderate level.
The results of the
Husband Support Scale categorization show that participants in the high
category are 43.1% (44 people), medium is 41.2% (42 people), and those low is
15.7% (16 people), meaning that the majority of participants feel anxious about
giving birth in the high category.
The results of the
categorization of knowledge about childbirth show that participants in the high
category are 62.7% (64 people), medium is 29.4% (30 people), and low is 7.8% (8
people), meaning that the majority of participants feel anxious about facing a
high category birth.
Multiple Regression Analysis
The findings of this research are the result of
hypothesis testing analysis carried out using Multiple Linear Regression
Analysis using the SPSS 25 for Windows program. The following are the results
of data processing from research carried out.
Table 2. Results of Simultaneous Regression Analysis
|
F
|
p
|
Information
|
|
31,990
|
0, 00 0
(p < 0.01)
|
Very Significant
|
Source: Output Statistics Program SPSS Series 25 IMB for Windows
The results of multiple linear regression analysis
obtained a value of F = 31.990 with a significance of 0.000 (p < 0.01),
meaning that there is a significant relationship between husband's support and
knowledge about childbirth and anxiety before giving birth for primigravida.
These results prove that the second hypothesis, which states that the husband's
support is negatively correlated with anxiety about facing primigravid birth,
is proven. This means that the research assumption states that the higher the
husband's support, the lower the anxiety in facing a primigravid birth. On the
other hand, if the husband's support is lower, the anxiety of facing a
primigravid birth is accurate.
Table 3. Partial Regression Results
|
Q
|
p
|
Information
|
|
- 4,268
- 7,388
|
0,000
(p <
0.01)
0,000
(p <
0.01)
|
Very
Significant
Very
Significant
|
Source:
Output Statistics Program SPSS Series 25 IMB for Windows
Based on testing, the husband's support obtained t = - 4.268 with p = 0.000
(p < 0.01). This means that the husband's support has a significant negative
impact on anxiety facing primigravida childbirth. These findings confirm that
the second hypothesis, which claims there is a negative correlation between the
husband's support and anxiety about facing primigravida childbirth, is true.
This means that the assumption in the research that a higher level of husband
support is related to a lower level of anxiety when facing a primigravid birth
is proven. On the other hand, higher levels of anxiety can indeed be related to
lower levels of husband's support when facing primigravida childbirth.
Knowledge about childbirth is t = - 7.388 with p = 0.000
(p < 0.01). In other words, there is a significant negative relationship
between knowledge about childbirth and anxiety when facing childbirth in
primigravidas. These findings indicate that the third hypothesis, which states
that there is a negative correlation between knowledge about childbirth and
anxiety about facing childbirth in primigravidas, is proven. This means that
the research results support the assumption that the higher the knowledge about
childbirth, the lower the level of anxiety experienced by primigravida when
facing the birth process. On the other hand, if knowledge about childbirth is
inadequate, the level of anxiety facing childbirth in primigravidas tends to be
higher.
R2 and Effective Contribution of Each Variable
The practical
contribution (SE) of the Husband's Support variable to anxiety facing
childbirth is 8.33%. Meanwhile, the effective contribution (SE) of the
Knowledge About Childbirth variable to Anxiety Facing Childbirth reached
30.97%. Based on these results, variable X2 has a more significant
influence on variable Y than variable X1. The total effective
contribution (SE) is 39.3%, the same as the coefficient of determination
(RSquare) in the regression analysis, namely 39.3%.
The relative contribution (SR) of the variable Husband's
Support (X1) to Anxiety Facing Childbirth (Y) is 21.2%. Meanwhile,
the relative contribution (SR) of the Knowledge About Childbirth variable (X2)
to Anxiety Facing Childbirth (Y) is 78.80%.
Acceptance of the first
hypothesis from the research, which states that the husband's support and
knowledge about childbirth are correlated with anxiety facing childbirth in
primigravidas. This means that the level of anxiety before childbirth in
primigravidas can be low if the individual has high husband support and
adequate knowledge about the birth process. As explained (Marwidah, 2017), the support provided by the husband can significantly
reduce the level of anxiety during childbirth. Additionally, adequate knowledge
can provide opportunities for pregnant women to obtain helpful information.
Support from the husband
has been proven to be one of the factors that can reduce the level of anxiety
facing childbirth, especially in the context of prenatal care (Mendrofa, 2019). This is because the husband is considered the wife's
closest source of social support. Husbands have an essential role in supporting
their wives with enthusiasm and full concern. They can also strengthen their
relationship by going for walks and conversing casually. Emotional support from
husbands positively impacts wives' psychological comfort and safety.
Apart from that,
according to (Naha & Handayani,
2018), knowledge plays an important role, especially in
preparation for the birthing process. This knowledge allows pregnant women to
understand and prepare optimally. Pregnant women need to understand the various
aspects that are generally felt during pregnancy so that they can prepare for
the necessary needs. A high level of knowledge can contribute to reducing the
risk of harm during childbirth. Overall, mothers with good husband support and
adequate knowledge tend to face the birthing process with calm, happiness, and
comfort (Novelia et al., 2022).
The second hypothesis of
the research, which states that there is a correlation between the husband's
support and anxiety regarding childbirth, shows that in the context of this
research, the husband's support is indeed related to the level of anxiety regarding
childbirth. In line with (Agustina, 2022) emphasizes that the husband's support is a factor that
can increase the mother's mental readiness, reduce anxiety levels, and create a
sense of security and comfort in facing the birthing process. The husband's
practical support and role have been proven to increase the mother's
psychological or mental readiness to face the birthing process.
Husbands also have a
crucial role in providing support, including instrumental support, items that
can help or make things easier for their wives, and needed services. Support
from husbands can potentially motivate pregnant women to access information and
receive antenatal care. The husband's support is practical and involves
informational support, such as providing reading materials such as magazines or
books about pregnancy or helpful advice for the wife. Apart from that,
emotional support is also an important part, with husbands providing feelings
of love, empathy, and trust to their wives during pregnancy. Husbands also
become a place for wives to vent their complaints during pregnancy.
Support from the husband
has a significant impact on the mother's psychological response, mainly because
the third trimester is associated with concerns regarding pregnancy risks and
preparation for the upcoming birth. In this period, the emotional aspect
becomes crucial in preparing oneself or increasing awareness of everything that
will be faced (Manurung & Panjaitan,
2019). The husband's support will motivate mothers to seek
information and access antenatal care services, including participation in
classes for pregnant women. This is because the husband's support is the
primary key to maintaining the mother's positive emotions during pregnancy and
ensuring the fetus's condition remains strong and healthy (Nurdiansyah, 2011). Apart from the husband's support, the results of this
thesis research also prove the third hypothesis that the better the knowledge
about childbirth, the greater the anxiety. Facing childbirth will be lower.
Therefore, to reduce anxiety about childbirth, knowledge about childbirth is
needed. As proven in research (Safitri, 2018), with increasing levels of knowledge, anxiety levels can
decrease. This happens because knowledge is vital in shaping and influencing a
person's attitude when facing the birthing process.
The knowledge possessed
by primigravidas can impact their behavior in preparing for and facing the
birth process. The more knowledge you have about childbirth, the more positive
responses you will have towards the process. In this way, primigravidas will
better prepare themselves physically and mentally to face childbirth and
actively participate in efforts to prevent possible complications that may
arise during the birth process.
The results of this
study show that the presence of the husband's support and knowledge has an
influence on anxiety before childbirth in primigravidae. This can be seen from
the high level of anxiety of 11.8% (12 people), medium 46.1% (47 people), and
low 42.2% (43 people). Participants had levels of husband support that were in
the high category at 43.1% (44 people), medium at 41.2% (42 people), and low at
15.7% (16 people). Furthermore, participants also had a level of knowledge in
the high category of 62.7% (64 people), medium 29.4% (30 people), and low 7.8%
(8 people), so it can be concluded from the descriptive results show that the
majority of participants have a moderate level of labor anxiety, husband's
support in the high category and level of knowledge in the high category. This
is due, among other things, to providing information and education through
counseling, counseling and maternal classes by health workers, and regular
pregnancy checks carried out by mothers according to standards at least four
times during pregnancy (Permenkes RI, 2014).
Based on the results of
practical contribution calculations, it is known that the contribution of
knowledge about childbirth to anxiety facing childbirth is more significant
than the husband's support. This indicates that good knowledge about the
birthing process has a more significant role than how much support the husband
has for the primigravida. Therefore, when a primigravida has adequate knowledge
about childbirth, she can be more accepting and better prepared for the birth
process that will be faced. The existence of this knowledge can provide calm to
primigravidas so that the level of anxiety facing childbirth can gradually
decrease. Primigravidas, who have good knowledge, tend to obtain accurate
information and have adequate literacy in searching for information that
supports preparation for the birthing process. In this way, they can better
understand preparation for childbirth.
This research provides
information that the results of calculating the effective contribution (SE) of
the variable Husband's Support for Anxiety Facing Childbirth is 8.33%. Apart
from that, the calculation results from this research show that the effective
contribution (SE) of the Knowledge About Childbirth variable to Anxiety Facing
Childbirth is 30.97%.
Based on the description above, it can be concluded that
there is a negative relationship between the husband's support and knowledge
and the level of anxiety facing childbirth in primigravida. These findings show
that the more positive the husband's support and knowledge, the lower the level
of anxiety. Conversely, the more negative the husband's support and lack of
knowledge, the more anxiety levels tend to increase. In addition, the
calculation results from this research show that the total effective contribution
of the husband's support and knowledge about childbirth to anxiety facing
childbirth reached 39.3%. This indicates that there are 60.7% other factors
that influence the level of anxiety facing childbirth, apart from the two
variables studied in this thesis. Several other factors may influence maternal
age, gestational age, parity (Vaira et al., 2023), education, maternal employment, husband's employment,
housing status, and household income (Soltani et al., 2017).
CONCLUSION
This study successfully uncovered a significant
relationship between husbands' support and knowledge about childbirth with the
anxiety levels of primigravida. The intriguing findings of this research
indicate that the higher the spousal support, the lower the anxiety levels
experienced by primigravida during the childbirth process. Additionally, a good
understanding of childbirth also plays a role in reducing the anxiety levels of
primigravida. The results of this study make a positive contribution to our understanding
of the importance of the husband's role and the level of knowledge about
childbirth in managing anxiety among primigravida.
The practical implications of this research involve the
development of more focused reproductive health education programs to enhance
husbands' involvement in providing support during pregnancy and childbirth.
Furthermore, the improvement of knowledge about the childbirth process can be
integrated into reproductive health education programs to minimize anxiety
during the prenatal stage. These implications are expected to positively
contribute to the mental and emotional well-being of primigravida, creating a
more positive childbirth experience, and strengthening family bonds.
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