DOI: https://doi.org/10.

53350/pjmhs211561526
ORIGINAL ARTICLE

Anxiety Level of Pregnant Mother in Facing Childbirth

INDRA ISWARI NINGSIH1, ROSMITA NUZULIANA2
Faculty of Health Sciences, Universitas ‘Aisyiyah Yogyakarta, Indonesia
1,2

Coresponden author to Rosmita Nuzuliana email : mitutcantik@gmail.com

ABSTRACT
Background: Pregnancy is a dramatic episode of biological conditions, psychological changes, and adaptation
for any woman experiencing it.
Aim: Some women may assume that pregnancy is an inevitable nature to pass, while others deem it a
determining event between life and death event for a new chapter of life. Some researches reveal the increasing
level of anxiety shared by pregnant women at the time of delivery.
Methods: This study used an observational analytical method with a cross-sectional approach. The samples
were 74 respondents taken using quota sampling. It applied the standard questionnaire for data collection, the
HARS questionnaire. The data were then analyzed with bivariate data of Chi-Square. It is revealed that 55.4% of
respondents experienced anxiety, which was triggered by several factors, including employment factors (ρ =
0.001), parity (ρ = 0.001), and maternal age factors (0.021).
Results: Women facing childbirth in Gamping II Primary Health Center mostly experienced anxiety due to risky
age with ρ = 0.002, primigravida with ρ = 0.001. In contrast, the mothers with low education experienced anxiety
with ρ = 0.080, and pregnant women with low education experienced ρ = 0.001.
Keywords: Anxiety, pregnant women, childbirth

INTRODUCTION passage, and passager that occurs due to anxiety can

Childbirth is a natural process that often leads to various indirectly result in fetal distress due to labor length [4].
problems of anxiety for those experiencing it. Anxiety levels Penumadu research conducted unveils that most
shared by women in facing childbirth are something primigravidas in severe anxiety levels were 46.7%, and the
common appearing physiologically. Surah Maryam verse majority of multigravidas at moderate anxiety levels were
22-23 says, "And the pains of childbirth drove her to the 72.3% [5]. Another study conducted by [6] at
trunk of a palm tree. She said, "Oh, I wish I had died before Fatrimesterawati General Hospital points out that out of 158
this and was in oblivion, forgotten." This is to say that the respondents, 52.5% of pregnant women experienced
existing anxiety is a natural process in dealing with anxiety. Whereas according to Yuliana's research (2010),
childbirth, but it will commonly increase in the last weeks concerning the Description of Anxiety in Pregnant Women
before labor. According to Andajani stated that 373,000 in Third Trimester, of 51 respondents studied, those
Indonesian pregnant women who experienced anxiety experiencing anxiety amounted to 49%, those with mild
related to childbirth amounted to 107,000 people (28.7%) anxiety were 47.1%, and moderate anxiety 3.9%
[1]. In Java, out of 67,976 pregnant women, 35,587 people respectively. Research in Indonesia asserts that pregnant
(52.3%) suffered from anxiety in facing childbirth. Even women who experience high anxiety levels can increase the
though it is commonly shared, disorders due to pregnant risk of premature birth and even miscarriage. Other studies
women's anxiety will increase to both mother and son's have shown that pregnant women with high anxiety during
emergent situation in childbirth unless it is treated seriously. pregnancy will increase the risk of hypertension in
Anxiety-related to childbirth occurs due to the release of pregnancy and labor/disrupted long-term labor [7]. Previous
stress hormones such as Adreno Cortico Tropin Hormones studies conducted by researchers in October 2017 at the
(ACTH), cortisol, catecholamines, β-Endorphins, Growth Gamping II Sleman Health Center reveal that 82% of the
Hormones (GH), prolactin, and Luteinizing Hormones (LH) / third-trimester pregnant women experience anxiety. The
Follicle Stimulating Hormones (FSH). The release of stress majority of pregnant women answered that they
hormones results in systemic vasoconstriction, including experienced anxiety, whether the child would be born with a
vasa Utero placenta constriction, which disrupts blood flow disability, anxiety during childbirth, and anxiety about not
to the uterus. The delivery of oxygen to the myometrium is having a smooth delivery. Unless treated seriously, anxiety
disrupted and results in weak muscle contraction of the in pregnant women will impact the physical and
uterus [2]. Vasoconstriction will also impede the organs psychological, both for the mother and fetus. Besides, it can
involved in the labor process from functioning correctly, also affect pregnancy and childbirth.
such as the muscles in the body, especially the muscles in
the birth canal that become stiff and hard, thus preventing it METHOD
from expanding, reducing the straining power, and This is an observational analytic study using a sectional
lessening physical power. cross-design. This study was conducted to determine the
On the other hand, May and Nelson (2012) describe factors associated with pregnant women's anxiety levels in
that anxiety in pregnant women before childbirth can the third trimester in dealing with childbirth. The research
stimulate the release of catecholamine hormones, which will population involved all third-trimester pregnant women (91
compress uterine activity. Disruption of uterine activity can pregnant women) examined at Gamping II Primary Health
cause irregularity, stiff birth canal, and disrupting the baby Center. The samples were calculated using the [8] formula
from childbirth position [3]. The imbalance between power, with a significance level of 0.05, resulting in 74

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Anxiety Level of Pregnant Mother in Facing Childbirth

respondents. This study used independent (age, parity, parity, 55.4% of pregnant women had high education
education, and work) and dependent variables (anxiety of (minimum education level of high school), 56.8% of the
pregnant women); for the sampling technique, the pregnant women worked, and 55.4% of the third trimester
researcher used quota sampling. This study's sample unit pregnant women experienced anxiety. In facing childbirth,
was third-trimester pregnant women at Gamping II Primary out of 40 pregnant women in the third trimester, 62%
Health Center, who was willing to be a respondent and did experienced moderate anxiety levels, and only 2% of
not have a poor obstetric history. The questionnaire used in pregnant women did not experience anxiety. Commonly, in
this study contained demographic data of respondents and the third trimester of pregnancy, pregnant women realized
HARS standard questionnaires in measuring anxiety levels that they would become parents awaiting the child's birth;
in facing childbirth. The research stages were conducted during this time, there would be a bond between parents
after the issuance of research ethics from the research and fetus. These pregnant women care much about the
ethics committee number 07 / KEP-UNISA / I / 2018 on safety of themselves and the child. Along with the
January 10, 2018. In this study, the primary data were expectation of a baby's presence, they also suffer from
directly obtained from the third trimester pregnant women at anxiety about the possibility of physical and mental defects
the Gamping II Primary Health Center of Sleman with an in the baby. Anxiety about physical pain and damage due to
assistant's help. The study was conducted after the childbirth and the possibility of a loss of control during
researcher conducted an introductory explanation by childbirth also needs to be addressed [9]. The older the
explaining how to fill out the questionnaire. The research pregnancy, the more the pregnant women’s fear and
was conducted at the time of the antenatal care schedule at anxiety of childbirth [10]. In the third trimester of pregnancy
the PHC. The respondents' data retrieval process was at the age of seven months of pregnancy and above, the
revealed by submitting informed consent to respondents, pregnant women's anxiety level is getting increasingly acute
giving questionnaires, and explaining to respondents how to and intensive since it gets closer to childbirth [11]. Fear of
fill out the questionnaire. Once the respondent finished childbirth ranks as the most case frequently experienced by
filling out the questionnaire, the questionnaire was mothers during pregnancy
collected, and the researcher confirmed the data's
completeness. Furthermore, the researchers analyzed and Table 2. Results of Chi-Square correlation test between Age, Parity,
Education, and Employment with Anxiety Levels in Third Trimester
processed the data by editing, scoring, and coding before Pregnancy in Facing Childbirth in Gamping II Primary Health Center
analysis. The analysis involved univariate analysis and Anxiety Levels
OR
bivariate analysis; for bivariate analysis, the researcher Variable Anxiety No anxiety Ρ
(CI 95%)
used a nonparametric chi-square statistical test. N % N %
Age
Risky 26 68.4 12 31.6 0.021 3.033
RESULTS AND DISCUSSION Not risky 15 41.7 21 58.3 (1.170 –
This research was conducted at Gamping II Primary Health 7.861)
Center, located in Gamping District, Sleman Regency, Parity
Primigravida 31 72.1 12 27.9 0.001 4.846
Special Region of Yogyakarta. The prioritized services of Multigravida 10 32.3 21 67.7 (1.791 –
this Primary Health center carried out since 2015 were 13.111)
reducing MMR and IMR, improving community nutrition to Education
reduce cases of malnutrition, and discovering and treating Basic 22 66.7 11 33.3 0.080 2.026
High-level 19 46.3 22 53.7 (0.793 –
TB cases and Ultrasonography (USG) examinations for 5.177)
pregnant women. Employment
Employed 25 78.1 7 21.9 0.001 5.804
Table 1 Frequency Distribution of Respondents by Age, Parity, Education, Unemployed 16 38.1 26 61.9 (2.043 –
and Employment at Gamping II Primary Health Center of Sleman. 16.488)
Characteristics f Percentage (%)
Age Based on table 2, it can be concluded that the factors
No risk 38 51.4
Risky 36 48.6
associated with anxiety in facing childbirth were age, parity,
Parity and occupation of respondents. Mothers who were at risky
Multigravida 31 41.9 age had an anxiety level surge of 3,033 times as high as
Prim gravida 43 58.1 those who were not at risky age. Primigravida's mothers
Education
had an anxiety level of 4,846 times as high as those with
High Level of Education 41 55.4
Primary Level of Education 33 44.6 multigravidas. Unemployed mothers had an anxiety level of
Employment 5,804 times as high as the employed mothers. The
Employed 42 56.8 distribution of respondents in the risky age group had a
Unemployed 32 43.2 more significant percentage since 68.4% of mothers
Anxiety Levels
Anxious 41 55.4
experienced anxiety than respondents who were not at risk,
Not anxious 33 44.6 with 58.3% experiencing anxiety. The statistical test
obtained a value of ρ = 0.021. Thus, it can be concluded
Table 1 describes the characteristics of respondents in that there is a significant relationship between age and
this study. It can be seen that 51.4 % of the respondents anxiety levels of pregnant women.
were pregnant women who were at risk because the age of The age that is considered the safest to get pregnant
these pregnant women was <20 years or> 35 years. and have childbirth is 20-35 years. At this age, the woman's
Besides, 58.1% of the pregnant women had primigravida physical condition is in top condition. Their womb has been

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 Indra Iswari Ningsih, Rosmita Nuzuliana

mature enough to protect the fetus, and they are mentally have higher knowledge and receive information faster than
ready to treat and maintain pregnancy carefully. At the age unemployed mothers [14].
of fewer than 20 years, pregnancy may trigger problems CONCLUSION
because their physical condition is not 100% ready. Some The results showed that 40 (54.1%) third-trimester pregnant
of the risks that can occur in teenage pregnancy are rising women experienced anxiety.
blood pressure and fetal growth inhibition. In addition to There is a relationship between age and the level of
pregnancy and childbirth, the risk of cervical cancer also anxiety in the third trimester of pregnant women facing
increases due to sex and childbirth. childbirth with ρ = 0.020. There is a relationship between
On the other hand, after 35, some women are parity and the level of anxiety in the third trimester of
classified as having high-risk pregnancies and congenital pregnant women facing childbirth with ρ = 0.001. The
abnormalities at the time of delivery. In this age period, the results reveal no relationship between education and the
maternal and infant mortality rates are increasing [12]. The level of anxiety of third-trimester pregnant women facing
distribution of respondents in the primigravida parity group childbirth with ρ = 0.080. There is a relationship between
was more significant than the 72.1% experiencing anxiety. employment status and the level of anxiety in the third
Statistical test results resulted in the value of ρ = 0.001. trimester of pregnant women facing childbirth with ρ =
Thus, it can be concluded that there is a significant 0.001.
relationship between parity and the level of anxiety of third- Acknowledgements: This research was supported by
trimester pregnant women in the face of childbirth. Universitas ‘Aisyiyah Yogyakarta Indonesia.
Parity is the frequency of labor that the mothers
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