Maternal Anxiety Before Labor During the Covid-19 Pandemic in

Bali Province

Idah Ayu Wulandari

Ni Wayan Manik Parwati

and Putu Ayu Ratna Darmayanti

Bachelor of Midwifery Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Keywords: Anxiety Level, Childbirth, COVID-19 Pandemic.

Abstract Stress in the third trimester of pregnancy will increase because they start preparing physical and emotional

readiness for childbirth. Before delivery, women might develop more stress due to the COVID-19 pandemic.

This descriptive study with a cross-sectional approach. The population of this study was pregnant women in

the third trimester from Bali Province. Selected through cluster sampling, 124 people. The data collection was

done using questionnaire. The data were analyzed by using descriptive statistics. The results show that the

majority of respondents did not experience anxiety (87.1%); 9.7% experienced mild anxiety, and 3.2%

experienced moderate anxiety. Midwives are expected to provide more frequent information that can support

pregnant women to face childbirth during the COVID-19 pandemic when serving pregnant women and their

families. In addition, families of pregnant women need to provide comprehensive support to pregnant women

and the general public by helping them comply with health protocols to avoid the transmission of COVID-

19.

1 INTRODUCTION

In the third trimester of pregnancy, the stress level of

pregnant women and their families increases due to

preparing physical and emotional readiness for

childbirth during the COVID-19 pandemic (Izzaty et

al., 1967). COVID-19 causes a global health crisis

such as high rates of infections and deaths every day

(Hardhana et al., 2021). Many countries try to control

the virus spread with preventive measures from the

government and the community (Kemenkes RI,

2020a). To cope with the increasing number of

COVID-19 cases, Java and Bali island had

implemented emergency public activity restriction

policies from 3 to 20 of July 2021 (Menteri Dalam

Negeri Republik Indonesia, 2021).

The increasing number of COVID-19 cases

certainly affects pregnant women, causing

psychological disorders before delivery (Izzaty et al.,

1967). Psychological disorders may include anxiety,

worrisome during pregnancy, and stress. Excessive

stress and anxiety during pregnancy is as dangerous

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as smoking (Rachmawati, 2019). Pregnant women

who experience stress will face more risk of giving

birth to babies with low birth weight (LBW), small

head size (microcephaly), and premature condition

than mothers who are mentally ready during their

pregnancies (Aprilia, 2010).

Anxiety is an unstable feeling in forms of

worrisome or concern. Based on ADAA data

(Anxiety and Depression Association of America),

52% of pregnant women report increased anxiety or

depression during pregnancy. Anxiety and worrisome

experienced by pregnant women will increase as the

time of delivery approaches. These problems always

arise in pregnant women, especially primigravida,

and thus need further treatment. Pregnant women

who experience anxiety increase cortisol levels which

can be related to the cause of low fetal weight.

Excessive anxiety are harmful for childbirth because

it may affect how women responds to their the

delivery process psychologically (Janiwarty, 2013).

Given that anxiety can adversely affect a mother and

her fetus, social support is very important for

Wulandari, I., Parwati, N. and Darmayanti, P.

Maternal Anxiety Before Labor During the Covid-19 Pandemic in Bali Province.

DOI: 10.5220/0011938800003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 45-48

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

pregnant women before and during delivery to reduce

the emotional distress (Rachmawati, 2019).

Psychological disorder i.e., anxiety during

pregnancy is associated with the occurrence of a

resistance index in the uterine arteries. Increased

concentration of noradrenaline in the blood plasma

will disrupt blood flow to the uterus. The uterus is

very sensitive to noradrenaline and can have a

vasoconstrictive effect. This mechanism results in the

inhibition of growth and development of the intra-

uterine fetus due to reduced oxygen and nutrition. As

a result, this inhibition process can contribute to low

birth weight (LBW) events. In addition, stress and

anxiety can increase corticotropin-releasing hormone

that interacts with the oxytocin and prostaglandins.

The oxytocin mediates uterine contractions,

contributing to premature birth (Rachmawati, 2019).

Given that anxiety can adversely affect the mother

and fetus, it is very important to provide social

support to pregnant women before labor and during

labor. Family support mainly helps prepare for

delivery and reduces negative feelings during

pregnancy and labor (Janiwarty, 2013).

Complications of birth and maternal death can be

avoided by providing good care, protection, and

assistance by integrating family, community, and

government. Mothers will experience a lot of

psychological changes in the third trimester, and thus

they need support during that period. The active

family support is very influential on mother and fetal

health and can prevent anxiety during pregnancy,

childbirth, and postpartum period (Ike, 2021).

2 MATERIALS AND METHODS

This study was a descriptive study with a cross-

sectional design (Nursalam, 2014). The population of

this study was all third trimester pregnant women

from Bali Province. Cluster sampling was employed

to select a total sample of 124 people (Sugiyono,

2017). The data collection was done using a

questionnaire, and the data were analyzed

descriptively. This study was granted an ethical

approval by the ITEKES Bali Ethics Committee.

3 STATISTICS

Statistical analyses were performed using SPSS

Statistics for Windows (Version 23, IBM corp.).

Factor variables were arranged descriptively in

frequencies and percentages.

4 RESULTS

4.1 Characteristics of Respondents

Table 1: Distribution of respondents based on their

characteristics.

Characteristics f (%)

Age

<20 years

20-35 years

>35

ears

10 (8.1)

77 (62.1)

37 (29.8)

Gravida

28 (22.6)

78 (62.9)

15 (12.1)

3 (2.4)

Education

Junior High School

Senior High School

Colle

21 (16.9)

93 (75)

10 (8.1)

Occupation

Does

not work

Entrepreneur

Private sector

employee

Civil servant

Othe

19 (15.3)

44 (35.5)

52 (41.9)

6 (4.8)

3 (2.4)

Based on Table 1, the majority of respondents were

20-35 years old (62.1%), had the second pregnancy

(62.9%), graduated from high school (75%), and

became civil servants (41.9%).

4.2 Anxiety

Table 2: Distribution of respondents by anxiety status.

Anxiet

Frequenc

Percenta

one 108 87.1

Mil

12 9.7

Moderate 4 3.2

Table 2 shows most respondents did not have anxiety

(87.1%) followed by mild anxiety (9.7%) and

moderate anxiety (3.2%).

5 DISCUSSION

Pregnant mothers need to put aside other things,

which can affect themselves and their baby before the

delivery process. However, the COVID-19 pandemic

becomes a strong stressing factor for anyone,

including pregnant women, with different reactions

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

to anxiety (Kementerian Kesehatan Republik

Indonesia, 2020). Anxiety is unstable feeling or

discomfort of thinking premonition which threatens

one’s emotion (Angeline & Simon, 2020).

Anxiety is an emotion that arises as an initial

response to psychological stress and threats to values

that are meaningful to individuals. It is often

described as a feeling of uncertainty, doubt,

helplessness, anxiety, worrisome, and unrest which is

often accompanied by physical complaints.

Childbirth process is a tiring and risky event. Not

surprisingly, mothers who are about to give birth are

shrouded in feelings of fear, panic, and nervousness.

Mothers await the presence of her baby as a part of

her. Mothers may have an unpleasant feeling when

the baby is not born on time. Fear of surviving, pain,

and danger also contributes to this feeling during

childbirth (Ike, 2021).

The impact of anxiety during labor the mother will

feel excessive pain or pain. Fear will hinder the birth

process because it can activate the center of alert and

defense in the body. As a result, little blood flow

comes to the uterus, thus blocking the labor process

and causing pain and tardiness in childbirth

(Meihartati, 2018). Pregnant women need to control

anxiety and face negative impacts faced by mothers

and their babies.

Family support can create a good relationship

between the family and the mother to deal with

anxiety (Angeline & Simon, 2020). However, family

may be a source of anxiety if there is conflict in the

family (Heriani, 2016). Families normatively can

support to fulfill one’s expectations. Adequacy of

family support is associated with decreased mortality,

quick recovery, cognitive function, physical, and

emotional health. In addition, the positive effect of

family social support may be helpful in stressful life

(Aprilia, 2010; Ni’mah, 2018).

Family support in childbirth is a source of strength

for mothers that cannot be provided by health

providers. Family support involves encouragement,

moral and material motivation, physical,

psychological, emotional, information, appraisal, and

financial support. Family support may come from the

person closest to the pregnant woman, especially

husbands. At all stages, social support enables

pregnant women to manage their health and

adaptation to life (Isnaini et al., 2020).

Family support is social support manifested in

terms of

emotional support such as empathy,

advanced support, counter-mental support through

direct assistance by giving property or goods, and

informational support through advice, suggestions, or

instructions (Ranita et al., 2016). Social support plays

a role in increasing self-esteem, buffering the effects

of stress, and contributing to a better psychological

status during the COVID-19 pandemic (Izzaty et al.,

1967).

Anxiety can be accompanied by behavioral,

emotional, and physiological responses. Individuals

with anxiety may display unusual behavior such as

panic for no reason, unreasonable fear of living

objects or conditions, repeated uncontrollable actions,

re-experience of traumatic events, or excessive

worrisome. On rare occasions, many people exhibit

one of these unusual behaviors as a normal response

to anxiety. The difference between this atypical

anxiety response and anxiety disorders is that the

anxiety response is severe enough to interfere with

one’s work, social life, and social environment. If this

is found before childbirth, it can affect mother’s and

her fetus’s health status (Heriani, 2016).

6 CONCLUSIONS

The majority of pregnant women in the third trimester

before the delivery process did not experience anxiety

(87.1%). Midwives’ advice may be helpful to provide

more frequent information about support for

childbirth during the COVID-19 pandemic in Bali

Province. In addition, families and the community

need to provide whole support to pregnant women by

implementing health protocols, preventing the

transmission of COVID-19.

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