Couples Communication Skills and Anxiety of Pregnancy: A Narrative Review.

BACKGROUND: physical problems during pregnancy including Anxiety disorders form a large share of health problems. On the other hand, healthy relationship and communication skills are vital to raise a family. For couples who enjoy communication skills, parenthood will be the best and most pleasant experiences in their lives. High levels of positive communication will lead to couples and their children's mental health and couples' good relationship can have a protective effect against stressors including anxiety of pregnancy. The current study reviewed the studies on the relationship between communication skills and the anxiety of pregnancy.
METHODS: The current study is a review where the researcher browsed the available databases like Google Scholar, Pubmed, Magiran, SID, and Science Direct and using key words of Communication skills, marital satisfaction, and the anxiety of pregnancy, & the researcher has searched the articles of 2000-2014 & read 150 abstracts & 93 full papers and ultimately, chose 50 to write this study.
RESULTS: By reviewing the findings literature in three general categories as Communication Skills as the Significant Component to Get Marital Satisfaction, Improving Marital Satisfaction as Pregnancy Anxiety Reducing Factor, and Communication Skills Quality as Component Influencing Pregnancy Anxiety.
CONCLUSIONS: Having communication skills will lead to promotion of marital satisfaction and increased mental health in life. It is, therefore, recommended that communication skills be trained in routine programs for pre-marriage counseling, pre-pregnancy cares and pregnancy so that the mental health of community can be improved.

1. INTRODUCTION

Pregnancy & parenting process is of the great psychological & biological changes associated with increased anxiety symptoms (1). Pregnant women’s physical health care in the developed countries has immensely improved over the last 100 years, though, emotional & mental health care of pregnant women has still been left as part of taken-for-granted part in obstetrics & delivery (2). However, the psychological disorders during pregnancy such as anxiety in the developing countries is higher & more common than that in the developed ones (3, 4). Most women are in pain from the fresh start or aggravating anxiety disorder during gestation (5). Despite the frequency of pregnancy period anxiety symptoms, the data on the anxiety disorders prevalence rates are limited (6). Yet the study has indicated that more than half of the pregnant women have anxiety symptoms (7).In another research, the incidence rate of antenatal anxiety has been considered 10.1% -75.6% (1). Various studies findings have revealed that anxiety is of pregnant mothers’ psychological nuisances and anxiety & worry rises in the first & third trimester (8-12).

Pregnancy born anxiety has reverse effects on the mother & her newly born infant’s health including preterm birth (1, 3, 13-15), lower birth weight (1, 6, 14-17), increased nausea and vomiting (1, 13), higher risk for preeclampsia (13, 18), lower Apgar score (3, 15), neurological disorders (2, 19), cognitive disorders and behavioral/emotional problems (2, 13). In some research cases, the relationship between maternal anxiety disorder & its transfer to the children has been displayed (13, 15). The women suffering from pregnancy anxiety visit their doctors more frequently that are more out of delivery fear & at the end, they resort to elective cesarean section (13). According to the conducted studies, antenatal anxiety risk factors involve low educational level, low income level, unemployment, lack of social support, marital difficulties and lack of husband’s support (1, 20, 21).

Healthy relationship & communication skills are vital for family nurturing. For the partners with communication skills capability, parenting will be of the most enjoyable life experiences for them and promote their own physical & psychological health and that of their children (22, 23). Having good relationship with spouse partner can have a protective effect against many stressful factors (14). Despite interrelationship being considered as one of the greatest achievements of man, normal people lack the potential to create an effective relationship (24). One of the most important problematic factors between couples refers to their relationships disorder (25). The studies on the couples confirm this issue that about 10-15% of married people frequently report significant communication conflicts (26). The ability to build an efficient relationship is of the most critical skills a person can own (27).

Diverse midwifery measures have been taken as the alternative treatment in order to meet individuals’ physical & mental needs covering mental image, gradual & progressive relaxation, music therapy & massage therapy (28). Diverse studies have concluded that training communication skills can affect marriage satisfaction & the other marital dimensions (29, 30). The survey by Litzinger et al. (2005) demonstrated that communication can independently predict marriage satisfaction (31) and on the one hand, the research by Babanazari et al. (2008) denoted that marital contentment is a determining pregnancy anxiety predictor (32). Regarding the mentioned studies, on the one hand, marital satisfaction is associated with pregnancy anxiety, but there is no study dealing with communication skills & pregnancy anxiety. Thus given the significance of anxiety & its effects on pregnant women, fetus, baby physical & mental health, the present study aims to review the couple’s communication skills & pregnancy anxiety relationship.

2. METHODOLOGY

The current study is a review where the researcher browsed the available databases like Google Scholar, Pubmed, Magiran, SID, and Science Direct and using key words of Communication skills, marital satisfaction, and the anxiety of pregnancy, & the researcher has searched the articles of 2000-2014 & read 150 abstracts & 93 full papers and ultimately, chose 50 to write this study The five steps were followed: identifying the research question; Search methods for Identifying relevant studies; study selection; charting the data, collating, summarizing; and Reporting the results (33, 34).

3. RESULTS

By reviewing the findings literature in three general categories as Communication Skills as the Significant Component to Get Marital Satisfaction, Improving Marital Satisfaction as Pregnancy Anxiety Reducing Factor, and Communication Skills Quality as Component Influencing Pregnancy Anxiety.

3.1. Communication Skills as the Significant Component to Get Marital Satisfaction

The studies indicate that training communication skills has been set forth as the peaceful discussions and it is more effective than the temporal & educational programs applied for primary & secondary prevention in reducing the couple’s disintegration & distress (35). Training communication skills results in family efficiency in issues such as problem solving, communications, roles, emotional accompaniment, emotional association or intercommunion, behavior control, & general family function (36). The more positive interaction between the couple, the higher problem solving & negotiation skills while the higher the negative interactions between them, the fewer the problem solving & negotiation skills. Also the studies imply that on the one hand, the couple’s negative interaction is the negative predictor of decision making skills, and on the other hand, the couple’s with higher positive interaction can talk about their good memories. The couple with good solving problem, negotiation and decision making skills & good memories report higher marriage compatibility (37). Imhonde (2008) drew this conclusion in the research that the couple’s communication has strong impact on marital satisfaction and also, love & affection being more psychological dimensions lead to higher intimacy since this can turn the parties worry into security (38). In addition, training communication skills has been introduced as the most effective method to make marital relationships closer because the depth of the intimacy created between two persons depends on their capability to convey thoughts, feelings, needs & desires clearly & effectively. If the couple can share each other’s feelings more comfortably & express their requirements without fear and misunderstanding by communication training, undoubtedly, they will get close in their relationships boosting all dimensions of their life (27).

3.2. Improving Marital Satisfaction as Pregnancy Anxiety Reducing Factor

Considering the conducted studies, it can be discovered that marriage contentment as a variable is closely associated with communication skills & the couples who are more successful in their relationships feel more satisfied with their marriage (31). On the other hand, it has been found that decent relationships between couples can have a protective effect against lots of stressful factors & dissatisfied marriage relationships can be a critical predictor of mother’s emotional distress in pregnancy (14). Besides, the research by Babanazari et al.(2008) displayed that some changes are expected as increased or decreased and then reincreased pregnancy anxiety in the first trimester of pregnancy but being young and low education at pregnancy period and high marital satisfaction play meaningful & highly critical roles in explaining the pregnancy anxiety difference rather than being at a special period of gestation. Their studies have indicated marital satisfaction as the most powerful predicting variable of pregnancy anxiety, that is, the higher marital satisfaction, the lower their anxiety; this relation definitely proves the very important role of partner to modify or aggravate pregnancy anxiety. The stressful or torturing relationship by the spouse can raise the woman’s mental disorders during gestation. Virtually, poor marriage relationship is the most stable predicting variable of anxiety & the other psychological health related issues in gestation. Thus one of the most important factors influencing woman’s adaptability with psychological pressures is the partner emotional support & secure marriage setting in this period. Not feeling affection about family circle & generally, disorder in marital relationships can increase anxiety, pregnancy aversion & subsequently, the pregnant woman’s psychological health drop (32). The studies have suggested that the pregnancy period perceived support by the partner is a predictor in the mother’s psychological health during prenatal time (39).

3.3. Communication Skills Quality as Component Influencing Pregnancy Anxiety

Reviewing the literature at hand implies that the most powerful gestation-born anxiety variable is marital satisfaction and marriage contentment holds a positive relationship with couple’s communication. On the one hand, the studies revealed a positive relationship between pregnancy anxiety & marital satisfaction; the research by Rini et al. (2006) demonstrated that the women enjoying more effective protection report less anxiety in their mid pregnancy and reduced anxiety from mid to late gestation (40). Plus the studies denoted that the women having less positive relationship with their partner experience higher anxiety compared with those with less negative relationship; in fact, Psychological adjustment during the transition to parenthood of both the women/men and the partner is impacted by the partner relationship (41). The research by Chan et al. showed that unwanted pregnancy, low self-confidence & low perceived support are of the factors resulting in significant psychological risk for anxiety symptoms during first pregnancy trimester (42). In other various studies, it has been asserted that low educational level, low income level, unemployment, lack of social support, marital difficulties and lack of husband’s support are of the risk factors of pregnancy anxiety (1, 20, 21). In the research by Van Bussel et al. (2009), it has been implied that Sociodemographic factors (age, marital status, socio-economical status), intrapersonal (self-esteem, neuroticism negative life experiences), social (marital dissatisfaction, lack of social support) and pregnancy related clinical (risk status of pregnancy, previous pregnancy experiences) are the variables accompanying higher anxiety levels in pregnant women (15). On the other hand, many studies revealed the relationship between marital satisfaction & communication skills; many studies have confirmed the positive correlation between these two variables that having communication skills can increase marital satisfaction & or promote couple’s contentment with marriage life (25, 43). The research by Litzinger et al. showed that communication can independently predict marital satisfaction and the couples being more successful in effective communication report higher marital satisfaction (31). In addition many studies indicated that training communication skills has a positive impact on enhancing relationship & boosting couples’ agreement (44).

4. DISCUSSION

In the present research, 150 abstracts, & 93 full reviewed papers & finally, 50 articles have been used to write it. Concerning the aforementioned points, it can be found that psychological problems including pregnancy born anxiety is high & this anxiety can create physical & psychological issues during gestation & even after delivery; also it can cause complications for the fetus & newly born baby and these complications can influence the child’s future. Given the studies, various risk factors are interconnected with pregnancy anxiety including low marital satisfaction (15, 20, 45). So that in some studies, marital satisfaction has been called as the most critical predicting variable of pregnancy anxiety (14, 32). That is, the more marriage contentment, the lower pregnancy born anxiety where the relationship signals the very decisive role of the partner in modifying or aggravating gestation anxiety (46).

Having good relationship with wife can render a protective effect against many stressful factors (14). The communication existing among the family members always has been considered of the most fundamental mechanisms to understand many sociopsychological behaviors such as anxiety (47). For the partners with communication skills potential, parenting is of the best & most enjoyable life experiences and will promote their & their children’s physical & psychological health (22, 23). Besides, it has been depicted that having positive interaction & problem solving, negotiation & decision making skills will enhance marriage adjustment. The findings by Esmaeelpour (2013) implied that communication skills have the highest role in the couple’s marital satisfaction (25). Also many studies have confirmed the positive effect of communication skills training on improving diverse life dimensions and marital contentment and psychological health (44, 48, 49).

The studies have displayed that the communication models and the relationship between couples can predict marital satisfaction & life quality better (38, 50). The studies by Cunningham (2003) revealed that the training course of communication enhancement can lead to higher marital satisfaction, lower communication problems and life quality increase (51). The goal behind communication training is to educate the skills & principles to the couples resulting in satisfied, supportive & stable relationships (38). Diverse foreign & even domestic studies have surveyed the effect & significance of couples’ communication and viewed communication of the important factors in physical & psychological health, compatibility & intimacy of the couples (38, 44). Training communication skills increase emotional accompaniment & couples relationships; in fact, it improves creating correct communication, & emotional intimacy between the couple. When family members apply effective communication models, they meet each others’ psychological needs (36). Diverse research cases have proved that the condition of couple’s communication is directly related with their psychological health (37). Different studies have also suggested that training communication skills affects married women’s psychological health (52). In fact in order to achieve family psychological health, we have to identify the factors affecting health, mental health,& life quality. One of these factors is to positively change family members’ communication manner with each other as the result of communication skills (51). Thus training communication skills influencing pregnancy anxiety will enhance marital satisfaction & having efficient communication can convert the parties worry into security (38). According to these findings, the importance of communication skills to prevent pregnancy anxiety & having pregnancy health is emphasized.

5. CONCLUSION

By reviewing the studies, it is possible to indirectly get the relationship between communication skills and pregnancy anxiety because marital satisfaction as a variable is connected both with communication skills & pregnancy anxiety. Considering the mentioned issues, the health team members especially the practitioners & consultant midwives are recommended to include communication skills training to the couples in their regular pre-marital consultation programs, pre-pregnancy & prenatal care so that the couples obtain a high level of marital satisfaction & overcome lots of psychological nuisances in pregnancy period and also through creating a decent & healthy communication with one another & the other ones, especially health care providers, the couples receive health-treatment care service with higher quality & more effectively, the issue that results in the mother’s physical & psychological health and also that of the fetus and this way, the psychological health of society will be boosted.