The relationship between self-compassion and fear of childbirth in pregnant women with gestational diabetes | BMC Pregnancy and Childbirth

Design and participants

This study was a cross-sectional study conducted on 75 primiparous pregnant women with GDM attending health centers in Kermanshah city, Iran in 2023. The sampling was done in a multi-stage manner. Firstly, the health centers of Kermanshah city were divided into 8 health districts, each considered as a Strata. In each strata, 2 to 3 comprehensive health centers were randomly selected. Then, the list of pregnant women covered by each of these comprehensive health centers was extracted, and samples were then randomly selected based on the inclusion criteria. The number of samples allocated in each selected center was determined based on the number of pregnant women in that center.

Sample size calculation

The sample size was calculated based on the results of a previous similar study [3]. The following equation was used to calculate the sample size:

In this equation, α = 0.05, β = 0.1, r = -0.358 and n = 75.

Inclusion and exclusion criteria

The inclusion criteria included primiparity, having at least basic literacy, having a healthy fetus, and being diagnosed with gestational diabetes. The exclusion criterion was complications during pregnancies and unwilling to participate.

Data collection

Study authorization was obtained from Kermanshah University of Medical Sciences (KUMS). The researcher introduced herself to the manager of each health center affiliated with KUMS. After explaining the research objectives and obtaining informed consent from participants, data collection commenced. The data were gathered from pregnant women who attended the selected health centers and met the inclusion criteria. This phase was conducted in the waiting rooms of the health centers. Data collection took place between May and October 2023.

Study instruments

The data collection tools included a demographic and clinical information form, the Self-Compassion Scale, and The Wijma Birth Expectancy / Experience Scale (W-DEQ A).

Demographic and clinical information form

Demographic and clinical information of study participants includes age, occupation, education level, insurance status, age at pregnancy, place of residence (city or village), number of prenatal visits, participation or non-participation in childbirth preparedness classes, desired or undesired pregnancy, and body mass index (BMI).

Self-compassion scale

The Self-Compassion Scale, developed by Neff and colleagues, consists of 26 items distributed across six subscales: self-kindness (Items 2, 6, 13, 17, and 21), self-judgment (Items 4, 7, 15, 20, and 26), common humanity (Items 1, 8, 12, and 22), isolation (Items 5, 11, 19, and 25), mindfulness (Items 9, 14, 18, and 23), and over-identification (Items 3, 10, 16, and 24). Responses are rated on a 5-point Likert scale ranging from 1 (completely disagree) to 5 (completely agree). Items 1, 2, 4, 6, 8, 11, 13, 16, 18, 20, 21, 24, and 25 are reverse-scored [18].

The Self-Compassion Scale is a self-report instrument designed to assess the characteristics associated with the subdimensions of self-compassion. Scores on the subscales of the Self-Compassion Scale are interpreted as follows: 1–2.5 points indicate low levels, 2.5–3.5 points indicate moderate levels, and 3.5–5 points indicate high levels of self-compassion. In Neff’s (2003b) study, the internal consistency reliability coefficients for the subscales were reported as follows: 0.78 for self-kindness, 0.77 for self-judgment, 0.80 for common humanity, 0.79 for isolation, 0.75 for mindfulness, and 0.81 for over-identification [28].

The validity and reliability of the Self-Compassion Scale were assessed in the study by Keshvari et al. (2013) in Iran. The Iranian version of the scale, like the original, comprises 26 items. The Cronbach’s alpha coefficient for the total scale was reported as 0.76. Moreover, Cronbach’s alpha coefficients for the sub-scales of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification were 0.81, 0.79, 0.84, 0.85, 0.80, and 0.83, respectively. The questionnaire’s validity was also reported as satisfactory [29].

In this study, scores from 26 to 60 were considered as average self-compassion, scores from 61 to 95 as good self-compassion, and scores from 96 to 130 as very good self-compassion.

In the present study, the reliability of the questionnaire was assessed using the split-half method and Cronbach’s alpha, resulting in values of 0.90 and 0.95, respectively.

The Wijma birth expectancy / experience scale

The Wijma Birth Expectancy/Experience Scale (W-DEQ-A) was developed by Wijma et al. (1998) to assess women’s fear of childbirth. This scale is utilized to measure the fear of childbirth in both women who have not yet given birth (W-DEQ-A) and those who have already experienced childbirth (W-DEQ-B) [30].

The Wijma Delivery Expectancy/Experience Questionnaire version A consists of 33 items, scored on a Likert scale from 0 to 5. The minimum score is 0, and the maximum score is 165. Items 2, 3, 6, 7, 8, 11, 12, 15, 19, 20, 24, 25, 27, and 31 are reverse-scored. Scoring equal to or less than 37 on the W-DEQ A questionnaire is considered as mild fear, scoring between 38 and 65 as moderate fear, scoring between 66 and 84 as severe fear, and scoring equal to or greater than 85 as clinical fear.

Vijma et al. assessed the reliability of the questionnaire using Cronbach’s alpha, which was reported to be 0.93.

The validation of this questionnaire in Iran was carried out by Ghadiri et al. The reliability of the questionnaire was assessed using the split-half method and Cronbach’s alpha, resulting in values of 0.86 and 0.93, respectively [31].

In the present study, the reliability of the questionnaire was assessed using the split-half method and Cronbach’s alpha, resulting in values of 0.88 and 0.95, respectively.

Data analysis

Descriptive statistics including mean, standard deviation, frequency, and percentage were used for data analysis. Correlation coefficient and the multivariable logistic regression analysis were used to determine the risk of child birth fear (categorical dependent variable) with a continuous independent variable (Self-compassion). To examine the predictors of fear of childbirth, we dichotomized the fear of childbirth variable into two categories: mild, and moderate to clinical. We then included the variables that had a p-value of 0.20 or less in the univariate analysis, which were associated with this dichotomized fear variable, into the multivariate regression model.

Multivariable model with the method of forward stepwise conditional were adjusted for the age, abortion history, gestational age, Mother’s education level, and occupation. Statistical analysis was performed using SPSS version 25 software, and a significance level of less than 0.05 was considered for all tests.