THE EFFECT OF EDUCATIONAL INTERVENTIONS ON KNOWLEDGE, PERCEIVED EFFICACY, SELF-EFFICACY, BEHAVIORAL INTENTION AND MODE OF CHILDBIRTH IN PREGNANT WOMEN

Although cesarean birth is performed as a necessary and life-saving solution, the
overuse of this procedure has lead to a health concern in most developed and developing countries,
including Iran.
The aim of this study is to determine the effect of educational interventions on knowledge, perceived
efficacy, self-efficacy, behavioral intention and mode of childbirth in pregnant women of two groups
of study, experiment and control.
Material & Methods: The present study is a field trial one with 572 low risk pregnant women
participating from all health care services all over the city of Shahroud. Continuous sampling using
random allocation was done. Participants in experiment group were instructed the fear management
and pain reduction skills in 8 sessions by qualified midwives. The level of knowledge, perceived
efficacy, self-efficacy and behavioral intention were measured using the structured questionnaire at the
beginning and the end of educations. Women in control group completed the same questionnaire two
times between at least 8 weeks time lag, and they were given routine prenatal care. Finally,
questionnaire’s variables, mode of childbirth and pregnancy outcomes were compared in two arms of
the study.
Results: The mean score of the questionnaire’s variables had significant differences before and after
educations in the experiment group. The mean score for knowledge was significantly higher in the
second time than the first time in control group, yet we did not observed such a finding for other
variables. Cesarean section rate was higher in control group compared to the experiment (52.5% vs.
35.9%). The odd of normal vaginal delivery was significantly higher in experiment than control group
(OR = 1.98, 95% CI= 1.41–2.70). A logistic regression analysis showed that women with at least one
previous normal vaginal birth and participation at educational sessions before 28 weeks of gestational
age were the most likely to deliver vaginal birth. Perinatal outcomes were similar in two arms of study
and we did not observe a significant difference between them.
Conclusions: The findings indicated that educational opportunity focusing on non-pharmacological
pain management methods to pregnant women can enhance their positive attitude toward vaginal birth,
empower them against the fear of childbirth and decline the maternal request for unnecessary cesarean
childbirth.