Abstract
Objective:The incidence of cesarean section (CS) was estimated as about 48% between 2000 and 2012 in Iran. This study was conducted to assess the effects of reviewing written childbirth scenarios on the selection of delivery method.Materials and Methods:This randomized controlled trial was conducted in Shohada Women’s Hospital in Behshahr, Mazandaran, Iran, from May to December 2015. A total of 223 women at 28 to 32 weeks of gestation were randomly allocated into three groups; the standard care (control), theory of planned behavior (TPB)-based education, and TPB education plus additional support via written childbirth scenarios (scenario). Participants were assessed at baseline (weeks 28-32) and intervention (week 37 of pregnancy) periods. Both intervention groups (TPB and scenario groups) participated in three learning sessions that were based on TPB, whereas the control group received routine care service.Results:The frequencies of normal vaginal delivery (NVD) in the scenario, TPB, and control groups were 73.2%, 58.5%, and 45.7%, respectively (p=0.004). The results showed that the relative risks of CS decision in the scenario and TPB groups in comparison with the control group were both 0.87 and statistically significant (p=0.018 and p=0.013, respectively). The relative risk of choosing CS after the removal of obligatory CS cases in the scenario group compared with the control was 0.85.Conclusion:Written childbirth scenarios that contain information on NVD and CS as additional support are effective educational tools for reducing CS rates.
Highlights
According to the World Health Organization (WHO), the ideal rate of cesarean section (CS) surgeries among healthy nulliparous women is 10% to 15%, but in many countries, it has continued to increase during the past three decades[1]
The results showed that the relative risk (RR) of the decision to undergo CS in the scenario and theory of planned behavior (TPB) groups in comparison with the control group were both 0.87 and statistically significant (p=0.018 and p=0.013, respectively)
Our results showed that using positive stories about childbirth in the TPB model is an effective strategy for enhancing the predilection of pregnant women to select normal vaginal delivery (NVD) as a delivery mode
Summary
According to the World Health Organization (WHO), the ideal rate of cesarean section (CS) surgeries among healthy nulliparous women is 10% to 15%, but in many countries, it has continued to increase during the past three decades[1]. Various studies have confirmed the importance of scenarios in learning[13,14] Peer experiences, such as narrating childbirth stories, influence the choice of delivery method[15] because negative stories about NVD motivated pregnant women to select CS[16,17]. In a study conducted by Blainey and Slade (2015), the writing and sharing of childbirth stories by women who experienced traumatic delivery exerted positive mental health effects on the women[18]. To address this capability of scenario, the present study evaluated the effects of reviewing written childbirth scenarios on the decision of nulliparous women regarding delivery method (i.e., NVD vs CS).
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