Motivating women and their partners to participate in childbirth education and increasing natural delivery rates in Iran

Abstract

Childbearing involves profound physical, psychological and social changes, as well as the considerable challenge of personal and family transition and adaptation, and there are important decisions to be made. It might be assumed, therefore, that participation in childbirth preparation would hold the same importance for childbearing women and their partners as other aspects of care, for example making antenatal visits. Yet, in common with many other parts of the world, few women in Iran participate in the free childbirth preparation available (Rasouli et al.). It is surprising that given considerable development of different approaches and an evidence base in childbirth preparation (Leap & Hunter. Supporting women preparing for labour and birth. In: Leap & Hunter. Supporting Women for Labour and Birth: A Thoughtful Guide. London: Routledge, 2016; 57–84) little attention appears to have been paid to motivating women to attend classes. This in itself makes the results of a randomised trial conducted in Iran to determine the effectiveness of motivational interviewing (MI) on women's participation in childbirth classes and their subsequent natural delivery, of considerable interest. In this RCT women were randomised into one of three groups: motivational interviewing (MI), a lecture, or the control group: 90, 59.7, and 27.3% of the women in these groups, respectively, attended classes. The frequency of natural delivery was 68.4, 54.4, and 48.1%, respectively. Motivational interviewing is described as a client-centred approach to support change that emphasises helping the client make his or her own decision and change, rather than external pressure. The approach to motivational interviewing was one of eliciting concerns, enabling the expression of uncertainty and ambivalence, empathy and supporting self-efficacy in childbearing women (Rasouli et al.). Although the use of MI has been described to enable difficult conversations, for example in relation to obesity, smoking and substance abuse (Raymond & Clements. MIDIRS 2013; 23:435–40) using MI to encourage attendance at childbirth preparation classes is unique. Iran has a high caesarean section rate and has a comprehensive strategy to reduce it. This strategy includes a recommendation for the provision of childbirth preparation in all services. Improving participation in classes will be important. It is possible that motivational interviewing, through the development of a therapeutic relationship of the counsellor with participants, was responsible for the increase in natural birth rather than participation in childbirth education per se. Nevertheless, this appears to be a promising approach. Further understanding may be achieved through a qualitative survey of women's experiences and feelings. None declared. Completed disclosure of interests form available to view online as supporting Information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.