Effect of supportive educational intervention on childbirth self-efficacy amongst primipara mothers: A randomized controlled trial

INTRODUCTION

A woman’s experiences with pregnancy, labour, and childbirth are multidimensional and can include all kinds of feelings.¹ Childbirth can be joyous and satisfactory, or anxious and horrifying. The thought of unfavourable events and pain during childbirth can be a reason for fear. Women tend to question themselves about their strengths, their capability to bear pain and whether they can give birth to babies like other women. The fear of childbirth can range from none to extreme.²

Fear of childbirth affects childbirth self-efficacy. Findings of one study showed that lower childbirth self-efficacy was related to high childbirth fear.³ Improvement of childbirth self-efficacy can be an important aspect of care for fearful pregnant mothers.⁴

Childbirth confidence is a marker of women’s coping abilities during labour and birth. Studies show that childbirth efficacy depends on parity. Although multiparous women reported higher confidence, primipara women have low birth efficacy and confidence. Women with low self-efficacy for birth can benefit from increased support through psycho-education by midwives.⁵ Educational interactions helped women build self-worth and improved childbirth efficacy, which improves the ability to bear pain. Women desire information and providing them with it increases their confidence and self-efficacy for childbirth.⁶

Women must believe that birth is possible and that birth is a natural process.³ Belief must be established in her body’s ability and strength to offer birth, and this self-efficacy can be achieved by knowledge and educational interventions by a care provider and in an environment where the women feels safe.⁷

We assessed childbirth self-efficacy amongst primipara mothers and the impact of educational interventions in a randomized controlled trial. We also assessed the association of childbirth self-efficacy with selected demographic variables.

METHODS

Primipara women in the age group of 20–35 years, with a fear of childbirth, attending the Obstetrics and Gynaecology out-patient department in Government Medical College and Hospital, Chandigarh were recruited.

Data collection procedures

Primipara mothers with a fear of childbirth who were 24–28 weeks pregnant, with a singleton pregnancy, a WDEQ score 61–85, 20–35 years of age, able to read and understand English/Punjabi/Hindi, and willing to participate in the study were recruited.

The calculated sample size was 196 subjects but we included 200 subjects. Subjects were explained the purpose of the study and confidentiality was assured to them. Written consent was obtained for their participation in the study. Randomization was done using lottery method. Mothers were asked to choose any sealed envelope from a bowl which had envelopes containing a slip with experimental and control group mentioned.

This was a single-blind trial, registered in the Clinical Trial registry of India (CTRI/2020/04/024523) and approved by our institutional ethics committee vide IEC No. GMCH/IEC/2019/336.

Women in the control group received information related to diet in pregnancy. Experimental group mothers received planned session I of the intervention. Researchers interacted with the primipara mothers to know about the cause of their fear and motivated them to talk about their fear so that possible solutions could be provided along with care of the mother during pregnancy. They were also asked to write about their negative beliefs and fears. The second session was at 32–36 weeks. At 37–38 weeks of pregnancy, selected mothers in both groups were again assessed for childbirth self-efficacy.

The study was conducted from March 2021 to November 2021. The CONSORT diagram of study flow is given in Fig. 1.

Close

FIG 1.

The consolidated standards of reporting trials (CONSORT) flow diagram

Export to PPT

RESULTS

There was a change in the number of primipara mothers who had scores above and below the median after the intervention while there was no change in the control group (Table 1).

Findings related to pre-test and post-test level of childbirth self-efficacy expectancy score: As shown in Table 2, in the experimental group, as per pre-test, 50 had both below median and above median scores. According to the post-test, 54 had below median and 46 had above median scores. In the control group, as per the pre-test, 51 had below median and 49 had above median scores. As per the post-test, 59 had below median and 41 had above median scores

At baseline, the CBSEI–Childbirth outcome expectancy score was similar in the two groups but was significantly higher in the experimental group as compared with the control groups (p<0.001, Table 3). The pre-test CBSEI–self-efficacy expectancy score of the two groups was also similar but the difference between mean post-test self-efficacy expectancy score of experimental and control groups was statistically significant (p<0.001, Table 4).

DISCUSSION

It is challenging to boost women’s belief in their ability to cope with normal physiological and psychological changes of pregnancy when they are frightened of childbirth.⁸ Low childbirth self-efficacy is directly related to fear of childbirth. During this study, we found that supportive educational intervention for primipara mothers with a fear of childbirth could significantly improve childbirth efficacy. Similar findings have been reported by Ip et al.⁹ where an efficacy-enhancing educational inter-vention was effective as the experimental group demonstrated a higher level of self-efficacy for childbirth than the control group (p<0.001). A meta-analysis and systematic review by Demirci et al.¹⁰ assessed the effect of antenatal education on childbirth self-efficacy amongst pregnant women. The findings reported that antenatal education had a positive effect on outcome expectancy and efficacy expectancy.

We concluded that supportive educational intervention was effective in primipara mothers for increasing confidence for childbirth.