Anxiety
Introduction
For women, pregnancy is an emotional time and anxiety is one of the many feelings that is experienced during and after the period. Nearly 20 per cent of women in pregnancy suffer from anxiety during pregnancy. Anxiety in pregnant women can be due to hormonal changes and emerging worries that may be caused by different factors. Although anxiety during pregnancy is normal, it needs to be effectively managed as it has adverse impacts on both mothers and their babies. The current pandemic is a unique stressor causing psychological distress in pregnant women leading to higher levels of anxiety in the group. Also, the new guidelines that require the use of enhanced personal protection equipment (PPEs) impact communication that has resulted in communication verbal and non-verbal issues. Additionally, social distancing required to prevent the spread of the virus continues to impacts the support of mothers where only one birth partner is allowed during childbirth—this paper reviews anxiety and communication research articles to examine their impacts and identify potential communication barriers.
Anxiety
Impact of Anxiety During Pregnancy
According to Shahhosseini, Pourasghar, Khalilian, & Salehi (2015), although pregnancy is one of the most pleasant and important events in women, it is also one of the most stressful events characterized with emotional crises. The authors indicate that anxiety is one of the most prevalent emotional crisis in pregnant women, which if not properly managed, can lead to undesirable consequences on mothers and their babies. It is, therefore, crucial for maternity staff to ensure that they constantly identify and screen anxiety disorders in pregnant women during pregnancy, labour, and delivery to prevent any undesirable consequences in both mothers and their babies.
Rapid changes being experienced due to the outbreak of COVID-19 have exacerbated anxiety in pregnant women due to the emergence of uncertainties and lack of enough information on the pandemic. Shahhosseini, Pourasghar, Khalilian, & Salehi (2015), indicate that high levels of anxiety during pregnancy and birth lead to fetus loss, decrease in birth weight, destruction of social behaviours, and reduction of fertility rates in women. Through a narrative review methodology, the researchers also found out that anxiety has significant impacts on biological indicators of newborns, blood flow to babies, and diet and sleep habits of women. As a result, it can be argued that anxiety during pregnancy and delivery has both short-term and long-term negative impacts on both babies and mothers.
Jomeen (2004) indicates that anxiety has been one of the major characteristics traditionally associated with psychological health status in pregnancy, childbirth, and postnatal period. Through a literature review, the article aimed at examining the constructs of anxiety and screening for, and identification of maternal psychological distress. Based on the author, there is a significant amount of evidence revealing that co-morbid anxiety is the major cause for the occurrence of postnatal depression (PND) and antenatal depression (AND) before and after childbirth. Also, the article in its literature review found out that anxiety disorder is a significant risk factor for postnatal mood disorders. It is, therefore, evident that anxiety has significant negative impacts on the psychological health status of women during pregnancy, childbirth, and postnatal period.
Due to anxiety increase in pregnant women to the outbreak of COVID-19, maternal staff has a duty to constantly monitor the psychological health of pregnant women before and after birth. According to Jomeen (2004), prolonged delays in the diagnosis of anxiety disorders in pregnant women is the major cause for psychological health problems such as postnatal depression during pregnancy and lack of compliance to pre-natal health regimes in women. The article goes beyond discussing the negative impacts of anxiety in pregnant women and advocates for the importance of early screening for psychological health to help pregnant women with anxiety disorders. As a result, it can be argued that with the changes being experienced due to the outbreak of COVID-19, maternal staff have a duty to screen for psychological health problems caused by anxiety disorders in women before and after childbirth to promote better experiences during pregnancy, childbirth, and postanatal period.
Evans, Morrell, & Spiby (2017) eximine the experience of women with anxiety during prgnancy and the also their views regarding the use if anxiety instruments in antenatal care. According to the authors, anxiety during pregnancy is the cause for adverse birth outcomes, infant behavioral and development problems, and postnatal depression. The major anxiety symptoms identified in the article among pregnant women include overwhelming feelings, anger, irritation, and inability to relax. Maternal staff, therefore, need to constantly monitor such sysmptoms when screening for anxiety problems in women during and after pregnancy. Based on the article, failure of identifying such factors results in higher levels of anxiety among women during pregnancy that can lead to futher complications such as low birtweight for gestational age, prematurity, and pregnancy-induced hypertension.
Fear during pregnancy execebrate anxiety in women necessitating the need for maternal staff to identify early sysmptoms and managing the problem. According to the article, adverse health outcomes during pregnancy can be prevented if maternal staff identify maternal anxiety sysmptoms and women who are at an increased risk (Evans, Morrell, & Spiby, 2017). Through the qualitative methodology, the researchers found out that most women lack the support that they need to discuss their anxities during pregnancy and their concerns regarding the use of anxiety instruments. With high levels of anxiety among pregnant women due to uncertanities caused by the emergence of COVID-19, clinician need to be more aware of anixety symptoms and their concerns regarding the use of anxiety instruments among pregnant women if adverse outcomes are to be prevented.
According to Beebe & Humphreys (2006), anxiety is one of the major factors that contribute to false and advance labor in women experiencing their first births. Based on the authors, although many nulliparous women plan and idealize their childbirths, anxiety usually arises due to lack of enough preparations for decisions associated with the management of early labor. Through an ethnographic qualitative analysis method, concerns regarding what labor will be like, how labor will be managed, and feelings of what labor will be like were identified as the main factors for anxiety and other emotions such dissociation and ambivalence in nulliparous women. As a result, it can be argued that anxiety in nulliparous women is as a result of the group lacking enough knowldege on labor that incites fear. With uncertanities caused by COVID-19 and lack of enough knowledge on the pandemic, nulliparous women are likely to have more queastions and fear that further execeberates their anxiety.
Communication
Importance of Communication
According to Ahmed (2020), both verbal and non-verbal communications are important factors during labor and birth. Based on the author, maternity care staff can ensure satisfaction of women with birth care by maintaining effective verbal and non-verbal communications. Both physical and mental stresses are unavoidable for women during pregnancy and delivery. As a result, pregnant women constantly need attention, empathy, guideance, support, and clinical care. Therefore, attitudes and behaviors, relationship quality between women and staff, and facilities’ resources and and atmosphere have significant impacts on the experiences of preganant women. Based on Ahmed, effective communication can help maternity staff positively impact the aforementioned factors in women during labor and birth to ensure positive birth experiences.
The article advocates for effective verbal and non-verbal communication to promote positive experiences among women during preganancy and birth. In the current times of rapid change due to COVID-19, maternal staffs are required to use PPEs such as surgical masks and eye protectors. Social distancing during deliveries further reduces mothers’ support from their loved ones necessitating the need for maternal staff to provide more support to ensure women have positive experiences during preganancy and birth. Through statistical analysis, the article’s cross-sectional study in Ebril citry found out women who were satisfied with verbal and non-verbal communication in delivery rooms were also satisfied with the care they received (Ahmed, 2020).
Higgins, Downes, Monahan, Gill, Lamb, & Carroll (2017) conducted a descriptive survey study to explore the barriers that midwives and nurses face in addressing mental issues among women during perinataln period. Based on the researcher, women are at risk of developing mental health problems in perinatal periods since pregnancy and early motherhood are stressful and emotional times for women. As a result, maternal staff have an obligation to discuss and address mental health issues with women during and after pregnancy. This is especially true with the execebration of anxiety among pregnant women due to the outbreak of COVID-19.
According to Higgins, Downes, Monahan, Gill, Lamb, & Carroll (2017), the main reson why midwives and nurses fail to discuss and address mental health issues with women during pregnancy is due to communication problems. The study identified communication break down problems, such as organizational factors including heavy workload resulting in lack of time, and underdeveloped communication skills among nurses and midwives. Based on the article, it is evident that nurses and midwives can help to reduce mental health issues such as anxiety disorders among women during pregnancy by maintaining effective communication and ensuring that they have well-developed communication skills. Communication barriers during rapid changes can lead to the development of mental health issues that can lead to adverse outcomes during childbirth.
According to Collins, Schrimmer, Diamond, & Bruke (2011), communication is essential during medical interviews as it positively impacts patients adherence, care satisfaction, and health outcomes. Rapid changes caused by COVID-19 pandemic calls for the need for clinicians to build trust and confidence with patients for effective care delivery and positive patient experiences. Women in pregranancy have numerous questions, fear, and are also anxious due to the impacts caused by social distancing and the use of PPEs to prevent the spread of the virus. According to Collins, Schrimmer, Diamond, & Bruke, (2011), both verbal and non-verbal communication skills are central to the development of trust and confidence between patients and health care professionals. Midwives and nurses in maternal care unit can leverage verbal and non-verbal communication to address some of the patients’ concerns regarding COVID-19 and why the new changes are necessary in the department. Based on the article, discrepancy in student interview skills with patients is due to the lack of well-developed verbal and non-verbal skills in the students that has resulted in unporposive behaviors and expressions hindering trust development.
Martin, Connor-Fenelon, & Lyons (2010) indicate that communication is one specific set of skills that is essential in the nursing profession. Based on the authors, intellectual disability nurses frequently come across patients with communication impairement regadless of the limited reseach regarding such experiences. The aim of the article was to conduct a literature review regarding communication between intellectual disability nurses and patients with intellectual disabilities. In their studies, the researchers found out that people with intellectual disabilities tend to have some degree of communication difficulties and it is the role of intellectual diability nurses to meet the need, especially since the prevelance of the problem is higher in the group. The authors revealed that communication barriers between intellectual diability nurses and patients with diabilities include lack of creativity and innovation in verbal and non-verbal communication in the nurses. It is, therefore, evident that although intellectual disability nurses have essential roles to play in meeting the communication needs of their patients, most of them lack creativity and innovation in their verbal and non-verbal communication. Also, mismatch of communications, overliance on verbal communication, and lack of enough knowledge about patients by nurses were also identified as other major communication barrier between intellectual diability nurses and service users. Although the article did not focus its research on the maternal field, indicated that communication is essential in all nursing care.
Conclusion
Anxiety is a common feeling in women during pregnancy and peranatal period. It can negatively impact the health of mothers and their babies if not effectively managed. Communication is also an important factor for ensuring women in pregnancy receive the best care they need. Communication can prove to be an effective tool to maternal staff in managing anxiety during pregnancy. However, the current pandemic has huge impacts on anxiety and communication. Women in pregnancy are having high levels of anxiety and also causing communication barriers. As maternal staff try to ensure that women in pregnancy continue to receive quality care, it will be crucial for the professionals to determine ways that can help to manage anxiety and overcome communication barriers.