The Effect of Spiritual Counseling on Stress and Anxiety in Pregnancy and Childbirth: A Randomized Controlled Clinical Trial

Abstract

Abstract Background: Considering the undesirable consequences of stress and anxiety during pregnancy, interventions that can control stress and anxiety in pregnant women will be very helpful. Spirituality has become widespread in recent years as another dimension of health in various medical fields. The aim of this study was to determine the effect of counseling with spirituality approach on stress and anxiety during pregnancy and childbirth (primary outcomes), postpartum depression, anthropometric indices of the newborn and type of delivery (secondary outcomes). Methods: This randomized controlled clinical trial recruited 112 pregnant women referring to health centers in Maragheh, Iran, in 2016-17. The participants were assigned to two 56-member groups of control and intervention with a randomized block design. The intervention group participated in spiritual counseling during 6 sessions of 60 minutes and the control group received routine care during pregnancy. Questionnaires of Perceived stress and Spielberger anxiety during pregnancy and childbirth, and the Edinburgh Depression Inventory at 6 weeks postpartum were completed through interviewing the participants by the researcher. Anthropometric indices were recorded from the newborn's monitoring card and the type of delivery was also entered into the relevant checklist by questioning the mother. Chi-square, t-test and general linear model were used for data analysis. Results: Fifty-five participants in the counseling group and 56 in the control group were followed up and analyzed until the end of the study. The two groups were same in terms of socio-demographic characteristics and the baseline scores of perceived stress, state and trait anxiety and depression. According to ANCOVA and controlling the baseline scores after intervention, mean score of perceived stress (adjusted mean difference= -3.4; 95% confidence interval= -2.3 to -4.4; P<0.001) and state anxiety (-2.1; -3.6 to -5.5; P<0.001) were significantly lower in the counseling group, while the two groups had no significant difference in terms of mean score of trait anxiety after the intervention. Based on ANCOVA and controlling the baseline scores, during childbirth, mean of state anxiety score (mean: -2.5; 95% confidence interval: -0.7 to -4.3; p= 0.007) was significantly lower in counseling group than control group, but there was no statistically significant difference between counseling and control groups in terms of the mean scores of trait anxiety (P= 0.640) and perceived stress score (p= 0.097) during labor. The mean post-partum depression scores in the control group compared with the intervention group (1.1; confidence interval 95%: 0.3 to 1.9; p= 0.009) was statistically decreased. The mean height and head circumference of the newborns in the counseling group was significantly higher than the control group (p<0.05). The frequency of vaginal delivery in the intervention and control group was not significantly different (p= 0.215). Conclusions: Spiritual counseling can control the perceived stress and state anxiety of pregnant women. Therefore, spiritual counseling is recommended as a complementary, effective and non-invasive intervention in controlling the psychological problems of pregnant mothers.