The Impact of Coping Classes toward Anxiety Level, and Coping

Ability during Labor

Runjati, Marsum, Sri Rahayu, Sri Wahyuni, Ida Ariyanti, Triana Sri Harjanti and Umaroh

Poltekkes Ministry of Health Semarang, Semarang, Indonesia

Keywords: Smart Mother Classes, Anxiety, Coping Ability, Labor.

Abstract: Backgrounds: Coping efforts carried out during pregnancy are very meaningful to influence pregnancy

outcomes and better birth, by minimizing or preventing negative influences from emotional, behavioral,

cognitive, and physiological responses.

Objectives: This study aims to analyze the impact of coping classes on anxiety levels and coping abilities

during labor.

Methods: This research was a type of experimental research design that used a Pre-test post-test control group

design. The samples were chosen randomly for 60 pregnant women who were given standard classes plus

coping classes and 60 pregnant women who were given standard pregnant mother classes which were carried

out in 12 clinics. Mother was given a class of 4 meetings. Measurements were taken three times before the

intervention, 4 weeks after the intervention, and during labor. This study used repeated ANOVA Post Hoc

LSD.

Results: The results showed that the score of anxiety in the intervention group at the second measurement

was lower as much as 0.896 (p = 0.502) and the score of anxiety during labor was lower as much as 0.563

(p = 0.683) than the control. The coping ability of the intervention group after the fourth week was higher by

1.740 (p = 0.284) and the coping ability of the intervention group at birth was higher by 3.942 (p = 0.030)

than the control group and the difference was significant.

Conclusion: The mother's classes Plus Coping Skills affect the level of anxiety, and coping skills during

delivery. Providing midwifery care uses continuity of care so that it can monitor and optimize preventive and

promotive effects.

1 INTRODUCTION

Pregnancy is a process that changes both physically

and psychologically for the mother (Hikmah et al.,

2019). Pregnancy is a major event in a woman's life,

not only affecting psychological, but also biological,

familial, and social domains (Lahti et al., 2017).

During pregnancy, there are significant changes

that can contribute to increased anxiety. (Corbijn van

Willenswaard et al., 2017) The prevalence of anxiety

disorders during pregnancy in developed and

developing countries is 10-25%.(Shahhosseini et al.,

2015) Meta-analysis of 102 studies found that the

prevalence of anxiety in pregnancy was 18.2% in the

first trimester and increased to 24.6% in the third

trimester.(Willenswaard et al., 2017) The results of

research in Indonesia stated that there were 26.4% of

Corresponding author

pregnant women experiencing anxiety (Hanifah &

Utami, 2019).

Pregnant women with anxiety during pregnancy

were shown to be three times more at risk of postnatal

depression and harmed the child's psychological

state. Anxiety conditions can increase the hormone

cortisol in utero so it is associated with impaired

cognitive development, behavioral problems, and

long-term emotions (Shrestha & Kd, 2018). In

addition, anxiety in pregnancy can affect the outcome

of childbirth (Zijlmans et al., 2017). Symptoms of

anxiety in pregnancy are related to the increased fetal

heart, fetal emergency, congenital malformation,

premature labor, and low body weight (Gejala &

Hasanjanzadeh, 2017; Shapiro et al., 2017; Yonkers,

K Hayden, K Forray, 2017). In Indonesia alone the

prevalence of Low Birth Weight (BBLR) is 6.2%

Runjati, R., Marsum, M., Rahayu, S., Wahyuni, S., Ariyanti, I., Harjanti, T. and Umaroh, U.

The Impact of Coping Classes toward Anxiety Level, and Coping Ability during Labor.

DOI: 10.5220/0010810000003347

In Proceedings of the 2nd International Conference on Psychological Studies (ICPsyche 2021), pages 159-166

ISBN: 978-989-758-580-7

159

(Kesehatan, 2018). Many bad consequences result

from maternal anxiety during pregnancy. Prevalence

is high, but a new study finds treatment rates are still

low (Kingston et al., 2017).

Pregnant women with anxiety have certain

characteristics and are affected by the environment.

Pregnant women with anxiety are influenced by

cultural background, tend to have a history of

infertility, unplanned pregnancies, and have low

psychosocial resources thus increasing anxiety. This

process can affect the mother, placenta, and fetal

systems especially when it occurs early in pregnancy

which is a sensitive period. (Dunkel Schetter &

Tanner, 2012) It is widely recognized that anxiety in

pregnancy can affect the neuro-endocrine

development of the fetus which will also affect the

emotional development of the fetus. (Olanike Busari,

2018) anxiety in pregnancy is also associated with

the incidence of short gestational age and fetal nerve

development. Mothers who experience anxiety may

also experience disorders during the postpartum

period (Dunkel Schetter & Tanner, 2012).

Anxiety during pregnancy is considered one of the

risk factors for fetal development because it can harm

the fetus related to prematurity, BBLR, childbirth

outcomes, and complications such as bleeding and the

risk of abortion. Anxiety levels will increase in the III

trimester of pregnancy. The anxiety is associated with

getting closer to the time of delivery. Facts show the

time approaching childbirth as a vulnerable condition

and trigger even feelings of fear for mothers who have

been pregnant before. These feelings of fear are more

likely to develop into anxiety (Nogueira & Alfenas,

2017).

Coping efforts carried out during pregnancy are

very meaningful to influence better pregnancy and

birth outcomes, by minimizing or preventing the

negative effects of emotional, behavioral, cognitive,

and physiological responses against stress. Coping

skills serve to select and implement appropriate

measures to cope with stress and as a defense resource

for pregnant women and children from the potentially

harmful effects of exposure to prenatal stress. A study

of coping skill training done on diabetes type 1

showed that coping skill training decreases

depression, anxiety, and stress among adolescents

with type 1 diabetes.(Edraki et al., 2018) Another

study that has done coping skill training during

pregnancy and measured after 4 weeks also showed

that coping skill training can decrease stress during

pregnancy and increase self-efficacy during

pregnancy.(Runjati et al., 2017) Coping responses are

associated with more favorable indicators of

psychological well-being. Coping during pregnancy

through positive assessment with an effort to create

positive meaning focused on personal development is

associated with better outcomes for mother and baby,

fewer depressive symptoms, and fewer problems in

pregnancy (Pakenham, KI; Smith A; Rattan, 2007).

In addition, one of the efforts to prevent problems

and complications during pregnancy is to increase the

knowledge of pregnant women and prepare for

childbirth, namely through classes for pregnant

women which are carried out on an ongoing

basis.(Emiyanti et al., 2017) The antenatal classes for

pregnant women are expected to better prepare

mothers psychologically and increase their

knowledge about pregnancy and the birthing process

so that it can help reduce maternal anxiety facing

childbirth. The study showed that physical and mental

changes caused by pregnancy, causing high levels of

stress, which is associated with adverse outcomes for

the mother and fetus and pregnant women require

coping strategies during pregnancy to combat these

created challenges. Coping with stress in mothers is

very important because it affects the mental health of

the mother and baby.

Other studies, especially on pregnant women,

have integrated mother classes activities with

maternal coping skills which allow mothers not only

to benefit from aspects of pregnancy and birth care

practices as well as postpartum and infant care but

also to help mothers with emotional aspects in dealing

with stress and confidence to face delivery during

pregnancy (Runjati et al., 2017), but the study that

integrated coping skill with mother classes stress have

not yet measured the mother's condition such as

anxiety and coping ability until the delivery process

by looking at the anxiety and coping ability outcome

when at labor process. This study aims to analyze the

impact of coping classes on anxiety levels and coping

abilities during labor

2 METHODS

This research is a type of research experimental

design. The design of this study used a pre-test post-

test control group design. The population in this study

were all primiparous pregnant women in the early 3rd

trimester (28-34 weeks gestation) at the Semarang

City Health Center that meet inclusion criteria as

normal pregnancy and exclusion criteria as a single

parent. The sampling method was cluster random

sampling for 12 public health centers from 35 public

health centers and then random allocation to be

experimental group and control group. The

experimental groups were given the combination of

ICPsyche 2021 - International Conference on Psychological Studies

160

coping skills and standard antenatal education

method ( n=60 ) pregnant women in 6 clinics and each

clinic 10 mothers chosen randomly from each clinic,

while the control groups were given only standard

antenatal classes( n=60) pregnant women at 6 clinics

and each clinic there were 10 mothers also chosen

randomly.

The Experimental groups were treated using

antenatal standard classes developed by the ministry

of health as a government program during antenatal

care and combine with coping skill education

developed by the previous study. The module of

antenatal classes has been developed by the ministry

of health as standard antenatal education as part of

antenatal care. While module of coping skill

education has been developed from previous research

and revised. (Runjati et al., 2017) Education classes

and coping skill classes were done four times in four

weeks and measured three times: before the

treatment, in the fourth weeks after the last treatment,

and during the delivery process for Anxiety and

coping ability during Labour.

The intervention was done by trained midwives

using the module of antenatal classes and the module

of coping skill education. The midwives who held

intervention groups were trained not only in antenatal

classes but also in coping skill education. While the

midwives who held the control group were trained

only in antenatal classes. The duration of the

intervention for each class for only standard antenatal

classes for 45 minutes and coping skill education for

45 minutes which the whole duration was about 1.30

minutes. The classes run four times for four weeks.

While The Control groups were given only

standard antenatal Classes four times in four weeks

and measured three times: before the treatment, in the

fourth weeks after the last treatment, and during the

delivery process for Anxiety and coping ability

during Labour. Pregnant women were measured

using anxiety scale instruments developed by a

previous study that has 26 questions with aspect

psychology and physiology with the result of validity

score was 0,366 s/d 0,764 P<0,05, and reliability sore

was 0,906. While the Instrument of coping ability

scale was developed also from a previous study with

37 Questions and the result of validity score was

0,337 s/d 0,683 P<0,05 P<0,05, and reliability score

was 0,906 (Sijangga, 2010).

This study using a different test to determine the

difference before and after treatment and the

difference in the mean of each measurement on the

anxiety variable, and Coping ability was measured at

the beginning, four weeks after the intervention, and

during the delivery. The analyzed data used the

repeated measured ANOVA test with Post Hoc LSD.

Ethical Clearance obtained from the Bioethics

Commission of the Faculty of Medicine, Sultan

Agung Islamic University Semarang number 510 /

VIII / 2019 / Bioethics Commission.

3 RESULT

The results of the different tests before the

intervention on the level of anxiety, and the ability to

cope during childbirth before treatment after four

weeks and during labor to see the difference between

the groups. The result pre-intervention between-

group showed the p-value on all variables showing a

p value> 0.05 so it was concluded that there was no

difference in the initial intervention in the two groups.

3.1

Proving the Effect of Maternity

Classes and Coping Skills on the

Anxiety of Pregnant Women during

Childbirth

The results are shown in Table 1 that the experimental

group that received standard classes plus coping skills

experienced a sharper decrease in the mean of anxiety

score. The different test was carried out between the

two groups based on the average change of each

group in three measurements, namely measurement 1

before treatment, measurement 2 was carried out at

week 4 after treatment and measurement 3 was

carried out at delivery using the Repeated ANOVA

test with post hoc LSD. The results of different tests

can be concluded that the class of pregnant women

plus coping skills can reduce the anxiety score of

pregnant women. The intervention groups at the

second measurement had an anxiety score of 0.896

which was lower than pregnant women who were not

given treatment/control but the difference was not

significant (p=0.502). It can be concluded that the

class of pregnant women plus coping skills can

reduce more the anxiety score of pregnant women

than control groups. While the score of anxiety at the

third measurement during labor was lower as much as

0.563 (p = 0.683) than the control group. It also can

be concluded that antenatal classes plus coping skill

education more reduced anxiety levels during labor

than control groups that were only given antenatal

classes even not significant.

Furthermore, Figure 1 showed that the

experimental group, the different test of Anxiety

scores before and after intervention on the fourth

weeks after the intervention and the third

The Impact of Coping Classes toward Anxiety Level, and Coping Ability during Labor

161

measurement at the time of delivery with the

Repeated measured Anova showed the mean score of

Anxiety before (52.71) and after the second

measurement (51.64) and the third measurement at

delivery (52.81) after the intervention. In the graphic

image, the anxiety score shows a decrease in the 2nd

measurement but at the time of delivery, it has

increased. In contrast in the control group the mean

score of Anxiety was before (52.71) and after the

second measurement (51.53) and the third

measurement at delivery (53.37). The graphic showed

that the intervention group had a trend of lower

anxiety levels at four weeks after intervention and

birth than the control groups.

Table 1: Differences in anxiety scores before and after

intervention by a group.

Group

Anxiety

Pre

Anxiety

Four weeks

Anxiety

At labor

mean ± SD mean ± SD

ean ± SD

Coping

Classes

53.23 ± 7,45 51.82 ± 7.66

52,93 ±

7,82

0,327

Standard

Classes

52.18± 9,86 52.35 ± 8.04

53,25 ±

4,62

0,630

Coping

Classes

-0.896 0.502 -0.563 0.683

pre vs post: Repeated Measured Anova, post hoc LSD

Figure 1: Anxiety score chart before and after intervention

in the experimental group (n=60) and the control group

(n=60).

3.2

Proving the Influence of Maternity

Classes and Coping Skills on the

Coping Abilities of Pregnant

Women and Childbirth

The results are shown in Table 2 that the experimental

group that received standard classes plus coping skills

experienced a sharper increase in the mean of coping

ability score. The different test was carried out

between the two groups based on the average change

of each group in three measurements, namely

measurement 1 before treatment, measurement 2 was

carried out at week 4 after treatment and measurement

3 was carried out at delivery using the Repeated

ANOVA test with post hoc LSD. The results of

different tests can be concluded that the class of

pregnant women plus coping skills can increase the

coping ability score of pregnant women. The

intervention groups at the second measurement had a

coping ability score of 1.740 which was higher than

pregnant women who were not given

treatment/control but the difference was not

significant (p=0.284). It can be concluded that the

class of pregnant women plus coping skills can

increase more the coping ability score of pregnant

women than control groups. While the score of

coping ability at the third measurement during labor

was higher as much as 3.942 (p = 0.030) than the

control group. It also can be concluded that antenatal

classes plus coping skill education more reduced

anxiety levels during labor than control groups that

were only given antenatal classes significantly during

labor. Interestingly the result of coping ability at the

third measurement of control groups during labor

showed a decrease significantly during labor while

the control group in contrast showed an increase

coping ability during labor even it was not significant.

Furthermore, The Changes in coping scores from

before the intervention in the first week to after the

intervention in the fourth week as well as changes in

the average coping scores at delivery are shown in

Figure 2. Figure 2 showed that the experimental

group, the different test of Anxiety scores before and

after intervention on the fourth weeks after the

intervention and the third measurement at the time of

delivery with the Repeated measured Anova showed

the mean score of coping ability before (117.78) and

after the second measurement (118.80) and the third

measurement at delivery (118.78) after the

intervention. It can be concluded from the graphic

image; the coping ability score shows an increase in

the 2nd measurement sharply but at the time of

delivery showed a slight decrease. In contrast in the

control group the mean score of coping ability showed

ICPsyche 2021 - International Conference on Psychological Studies

162

before antenatal education was (117.78) and after the

second measurement was decreased slightly (117.08)

and the third measurement at delivery showed the

coping ability was a decrease sharply (114.84). it can

be concluded from the graphic that the intervention

group had a trend increase of coping level at four

weeks after intervention and a slight decrease of coping

ability at birth than the control groups.

Table 2: Differences in Coping Scores before and after

intervention by a group.

Coping

ability

Pre

Coping

Ability

Four weeks

Coping

Ability

At labor

mean ± SD mean ± SD mean ± SD

Coping

Classes

116.17 ±

9.46

118.00 ±

9.71

118.02 ±

9.46

0.178

Standard

Classes

119.38±

10.16

117.87 ±

10.26

115.55 ±

11.62

0.045

Coping

Classes

1,740 0.284 3,942 0.030

pre vs post: Repeated Measured Anova, post hoc LSD

Figure 2: Coping score chart before and after intervention

in experimental group (n=60) and control group (n=60).

4 DISCUSSION

4.1

Proving the Effect of Maternity

Classes and Coping Skills on the

Anxiety of Pregnant Women during

Childbirth

The results of different tests can be concluded that the

class of pregnant women plus coping skills can

reduce the anxiety score of pregnant women ( 0.896

)which was lower than pregnant women who were not

given treatment/control but the difference was not

significant (p=0.502). furthermore, the score of

anxiety level during labor was lower as much as 0.563

(p = 0.683) than the control group.

Anxiety is a feeling of worry as if something bad

will happen and feeling uncomfortable as if there is a

threat. The more pregnancy the mother will feel more

anxious. Maternal anxiety is felt to increase due to

increased discomfort in pregnancy and also the

approaching labor process. A mother may feel fear of

the pain and physical danger that will arise at the time

of delivery.(H. Keliat et al., 2011) Anxiety and stress

during pregnancy are often overlooked when it is

important to pay attention. Midwives should

recognize anxiety and overcome it by providing

information and explanations about anxiety during

pregnancy and at the time of birth by providing

antenatal classes plus coping skill classes. The study

showed that anxiety during pregnancy and at birth can

influence the outcome of the health of the mother and

fetus and also the outcome of birth and after birth

during the postpartum period.(Blackmore et al., 2016)

increase anxiety during pregnancy also has a risk to

have a preterm birth.(Kartal & Oskay, 2017) It can be

also explained as a result of anxiety and fear, many

mothers experience more severe pain commonly

referred to as fear-tension-pain that influences the

outcome of birth. Fear causes anxiety so that muscles

become stiff and cause pain. (Sartika & Susilawati,

2021) So that emotional support is needed in

pregnancy and facing childbirth which can be

provided not only antenatal classes but also by

providing coping skill classes. Furthermore, health

care providers included midwives need to be sensitive

about the adaptation of active approach styles in

coping that are needed for pregnant women. The

combination of antenatal classes and coping skill

education provide more comprehensive information

and trained skilled how pregnant women overcome

the feeling of anxiety using problem-focused coping

and emotional-focused coping. The method of

problem-focused coping and emotional-focused

coping was trained in the experimental group to

provide the ability for mothers to overcome anxiety

during pregnancy and also manage feeling anxiety

facing labor and during labor. It is effectively that

manage anxiety could provide mothers cope better

with uncomforted feelings during pregnancy and at

birth.

Pregnant women express anxiety during their

pregnancy until the delivery process they will face

The Impact of Coping Classes toward Anxiety Level, and Coping Ability during Labor

163

and it causes stressors. The results showed that the

experimental group who received antenatal classes

and coping skill classes experienced a sharper

decrease in the mean anxiety score on the 2nd

measurement after 4 weeks compared with the control

group who received only standard antenatal classes.

Thus the results of the study are consistent that the

individual response to stressors in the form of anxiety

and times of anxiety is determined by coping, namely

oriented and intra-physical efforts to manage the

environment and internal needs as well as conflicts

regarding this matter. Furthermore, coping efforts can

affect birth outcomes by serving to minimize or

prevent negative emotional, behavioral, cognitive,

and physiological responses to stress. As a result, the

ability to select and implement appropriate coping

responses can serve as an endurance resource that

buffers pregnant women and their children from the

potentially harmful effects of prenatal anxiety and

stress exposure.(Guardino CM, 2015) Thus can be

concluded that coping skill education was useful to

provide pregnant women the ability to cope with

anxiety during facing labor by modification and doing

such positive behavior to minimize anxiety.

4.2

Proving the Influence of Maternity

Classes and Coping Skills on the

Coping Abilities of Pregnant

Women and Childbirth

The results showed in Table 2 that the experimental

group who received coping classes experienced a

sharper increase in the average coping ability after the

fourth week and the coping ability of the intervention

group at birth was higher than the control group and

the difference was significant.

Coping is a process in which individuals try to

find out the distance that exists between demands

(both demands that come from individuals and those

from the environment) and the resources they use in

dealing with situations that arise stress full.(Lazarus

RS, 1984; Taylor, 2015)

Coping strategy emphasizes

the effort or a process, where the individual tries to

resolve or deal with an event or events that are

considered stressful. The trick is to change his

cognition to control, tolerate, reduce, or minimize

pressure situations, to find a sense of

security.(Aldwin, 2007) the study showed that

coping skill education is more effective to train

mothers' ability to do coping during pregnancy and

labor. The coping ability is very important, based on

the study ability to cope with anxiety and stress

during pregnancy and labor was effective to

overcome the worst birth outcome(Kartal & Oskay,

2017; Sharon-David & Tenenbaum, 2017).

Furthermore, coping skill ability that was treated

during pregnancy integrated standard antenatal

classes was beneficial for mother not only has skills

pregnancy, birth and baby and postpartum care but

also ability to develop the coping ability to modified

some skill facing a delivery. The other research also

has proved that there was a high correlation between

coping ability with the stress of pregnant women. The

study also stated that better coping ability during

labor would result from a better outcome of

pregnancy and birth. (Sarani et al., 2016) It can be

concluded that mother who received antenatal classes

with coping skill classes has more skill ability to cope

better during pregnancy and facing labor and during

labor than mother only provided antenatal classes. A

previous study proved that better coping will decrease

stress during pregnancy and better outcomes of birth

and postpartum.(Goletzke et al., 2017) Coping ability

was found very useful trained during pregnancy as the

study found that women who have coping ability

better will have larger scores in self-efficacy and

carried out more coping behavior strategies during

labor. Pregnant women also had a more positive

evaluation of the childbirth experience and showed

significant gains in satisfaction after childbirth. It was

also needed assessment the level of confidence

women have in their ability to cope with the birth and

ability to have a vaginal birth. Furthermore, the study

also said that there were also need health care proved

should provide coping skill education to mothers so

that it can increase satisfaction with the childbirth

experience by helping to enhance self-efficacy and

coping in pregnant women (Report, 2017).

5 CONCLUSION

Based on the study result it can be concluded that

standard classes plus coping skills have a better

impact to decrease anxiety levels during pregnancy

and birth and improve coping ability during

pregnancy and birth.

The provision of midwifery care uses continuity

of care so that it can monitor and optimize preventive

and promotive efforts. In addition, it can provide

holistic and comprehensive care including bio,

psycho, social, and spiritual. For further researchers,

it is hoped that they can develop research on

psychological well-being in postpartum mothers and

child development.

ICPsyche 2021 - International Conference on Psychological Studies

164

ACKNOWLEDGMENTS

Thank you to pregnant women as well as midwives at

the clinic and PMB for their willingness to participate

in the research. Acknowledgments to Poltekkes

Kemenkes Semarang for providing funding for this

research.

REFERENCES

Aldwin, C. M. (2007). Stress, coping, and development: an

integrative perspective, 2nd edition (2nd editio). The

Guilford Press.

Blackmore, E. R., Gustafsson, H., Gilchrist, M., Wyman,

C., & G O’Connor, T. (2016). Pregnancy-related

anxiety: Evidence of distinct clinical significance from

a prospective longitudinal study. Journal of Affective

Disorders, 197, 251–258. https://doi.org/10.1016/

j.jad.2016.03.008

Corbijn van Willenswaard, K., Lynn, F., McNeill, J.,

McQueen, K., Dennis, C.-L., Lobel, M., & Alderdice,

F. (2017). Music interventions to reduce stress and

anxiety in pregnancy: a systematic review and meta-

analysis. BMC Psychiatry, 17(1), 271.

https://doi.org/10.1186/s12888-017-1432-x

Dunkel Schetter, C., & Tanner, L. (2012). Anxiety,

depression and stress in pregnancy: Implications for

mothers, children, research, and practice. Current

Opinion in Psychiatry, 25(2), 141–148.

https://doi.org/10.1097/YCO.0b013e3283503680

Edraki, M., Rambod, M., & Molazem, Z. (2018). The effect

of coping skills training on depression, anxiety, stress,

and self-efficacy in adolescents with diabetes: A

randomized controlled trial. International Journal of

Community Based Nursing and Midwifery, 6(4), 324–

333. https://doi.org/10.30476/ijcbnm.2018.40839

Emiyanti, Rahfiludin, M. Z., & Winarni, S. (2017). Analisis

Faktor-Faktor Yang Berhubungan Dengan

Keikutsertaan Kelas Ibu Hamil Januari-Juli Tahun

2017. Jurnal Kesehatan Masyarakat (e-Journal), 5(4),

801–811.

Gejala, D., & Hasanjanzadeh, P. (2017). Hubungan antara

ibu Umum dan Spesifik-Kehamilan Stres , Kecemasan ,

dan. 11(4), 4–7.

Goletzke, J., Kocalevent, R.-D., Hansen, G., Rose, M.,

Becher, H., Hecher, K., Arck, P. C., & Diemert, A.

(2017). Prenatal stress perception and coping strategies:

Insights from a longitudinal prospective pregnancy

cohort. Journal of Psychosomatic Research, 102, 8–14.

https://doi.org/10.1016/j.jpsychores.2017.09.002

Guardino CM, S. C. (2015). Coping during pregnancy : a

systematic review and recommendations. Health

Psychol., 8(1), 70–94. https://doi.org/10.1080/

17437199.2012.752659.Coping

H. Keliat, B. A., Wiyono, A. P., & Susanti. (2011).

Manajemen Kasus Gangguan Jiwa: CMHN

(Intermediate Course). EGC.

Hanifah, D., & Utami, S. (2019). The Associated Factors of

Antenatal Anxiety. 5, pISSN 2(01), 77–88.

Hikmah, N., Naimah, & Yuliani, I. (2019). Self Efficacy Ibu

Hamil Trimester III dengan Tingkat Kecemasan

menghadapi Persalinan. 5(2), 123–132.

Kartal, Y. A., & Oskay, U. Y. (2017). Anxiety, Depression

and Coping with Stress Styles of Pregnant Women with

Preterm Labor Risk. International Journal of Caring

Sciences, 10(2), 716–725.

Kesehatan, K. (2018). Hasil Utama Riskesdas 2018.

Kingston, D., Austin, M., & Zanten, S. V. Van. (2017).

Pregnant Women ’ s Views on the Feasibility and

Acceptability of Web-Based Mental Health E-Screening

Versus Paper-Based Screening : A Randomized

Controlled Trial Corresponding Author : 19, 1–18.

https://doi.org/10.2196/jmir.6866

Lahti, M., Braeken, M., Rooij, S. R. De, Hoyer, D.,

Roseboom, T., Katri, R., King, S., & Schwab, M.

(2017). Prenatal developmental origins of behavior and

mental health: the influence of maternal stress in

pregnancy. Neuroscience and Biobehavioral Reviews.

https://doi.org/10.1016/j.neubiorev.2017.07.003

Lazarus RS, F. S. (1984). Stress, appraisal, and coping. In

Behaviour Research and Therapy (Vol. 23, Issue 6).

spinger Publishing Company, Inc.

Nogueira, D. A., & Alfenas, U. F. De. (2017). Anxiety in

pregnancy : Prevalence and associated factors Anxiety

in pregnancy : prevalence and associated factors *.

September. https://doi.org/10.1590/s1980-220x201604

8003253

Olanike Busari, A. (2018). Multiple sclerosisPrevalence

and Associated Factors of Anxiety and Depression

Among Pregnant Women. Open Access Journal of

Neurology & Neurosurgery, 9(2).

https://doi.org/10.19080/OAJNN.2018.09.555758

Pakenham, KI; Smith A; Rattan, S. (2007). Application of

a stress and coping model to antenatal depressive

symptomatology. Psychology, Health, & Medicine,

12(3), 266–277.

Report, T. (2017). Self-efficacy , use of coping behavior

strategies and experience of childbirth in low-risk

pregnancy. June. https://doi.org/10.13140/RG.2.2.21

810.50883

Runjati, ., Susanto, H., Sawitri, D. R., & Thaufik, S. (2017).

The Effect of Antenatal Class Plus Coping Skill

Training on the Level of Stress and Childbirth Self-

Efficacy. Advanced Science Letters, 23(4), 3329–3333.

https://doi.org/10.1166/asl.2017.9125

Sarani, A., Azhari, S., Mazlom, S. R., Sherbaf, H., &

Aghamohammadian, M. (2016). The relationship

between coping strategies during pregnancy with

perceived stress level in pregnant mothers

10.22088/jbums.18.7.7. J. Babol Univ. Med. Sci, 18(7),

7–14. https://doi.org/10.22088/jbums.18.7.7.

Sartika, Y., & Susilawati, E. (2021). Pendampingan dan

Penerapan Modul Healing Touch Dalam Mengatasi

Kecemasan Pada Persalinan Oleh Bidan Klinik/Pmb

Di Kota Pekanbaru. 1(2), 1–6.

Shahhosseini, Z., Pourasghar, M., Khalilian, A., & Salehi,

F. (2015). A Review of the Effects of Anxiety During

The Impact of Coping Classes toward Anxiety Level, and Coping Ability during Labor

165

Pregnancy on Children ’ s Health. 27(April), 200–202.

https://doi.org/10.5455/msm.2015.27.200-202

Shapiro, G. D., Séguin, J. R., Muckle, G., Monnier, P.,

Fraser, D., Shapiro, G. D., Séguin, J. R., Muckle, G.,

Monnier, P., & Fraser, W. D. (2017). Sebelumnya

kehamilan hasil dan kecemasan kehamilan berikutnya

dalam kohort prospektif Quebec.

https://doi.org/10.1080/0167482X.2016.1271979

Sharon-David, H., & Tenenbaum, G. (2017). The

Effectiveness of Exercise Interventions on Coping with

Stress: Research Synthesis. Studies in Sport

Humanities, 22, 19–29. https://doi.org/10.5604/

01.3001.0012.6520

Shrestha, S., & Kd, P. (2018). Anxiety on Primigravid

Women Attending Antenatal Care : A Hospital Based

Cross-sectional Study. XX(X), 29–33.

Sijangga, W. N. (2010). Hubungan antara strategi coping

dengan kecemasan menghadapi persalinan pada ibu

hamil hipertensi.

Taylor, S. E. (2015). Health Psychology. In Journal of

Chemical Information and Modeling (Vol. 53). Mc

Graw-Hill Education.

Willenswaard, K. C. Van, Mcneill, J., Dennis, C., & Lobel,

M. (2017). intervensi musik untuk mengurangi stres

dan kecemasan dalam kehamilan : review sistematis

dan meta-analisis. 1–9.

Yonkers, K Hayden, K Forray, A. L. (2017). Association of

Panic Disorder, Generalized Anxiety Disorder, and

Benzodiazepine Treatment During Pregnancy With

Risk ofAdverse Birth Outcomes. 06510.

https://doi.org/10.1001/jamapsychiatry.2017.2733

Zijlmans, M. A. C., Beijers, R., Riksen-walraven, M. J., De,

C., Zijlmans, M. A. C., Beijers, R., Riksen-walraven,

M. J., & Weerth, C. De. (2017). Ibu akhir kecemasan

kehamilan dan stres dikaitkan dengan kesehatan anak-

anak : studi longitudinal. 3890. https://doi.org/10.1080/

10253890.2017.1348497

ICPsyche 2021 - International Conference on Psychological Studies

166