Abstract
ObjectivePreference for caesarean birth is associated with higher fear and lower self-efficacy for vaginal birth. Vicarious experience is a strong factor influencing self-efficacy in nulligravid women, and is increasingly accessible via digital and general media. This study assessed the effect of exposure to different birth stories on nulligravid women’s childbirth preferences and the factors mediating these effects.MethodsNulligravid women (N = 426) were randomly allocated to one of four conditions exposing them to written birth stories. Stories varied by type of birth (vaginal/caesarean) and storyteller evaluation (positive/negative) in a 2 × 2 design. Childbirth preference, fear of labour and vaginal birth, and self-efficacy for vaginal birth were measured before and after exposure via a two-way between groups analysis of covariance. Hierarchical regression models were used to determine the mediating effects of change in childbirth fear and childbirth self-efficacy.ResultsVariations in type of birth and storyteller evaluation significantly influenced childbirth preferences (F (1, 421) = 44.78, p < 0.001). The effect of vaginal birth stories on preference was significantly mediated by fear of labour and vaginal birth and self-efficacy. Effects of exposure to caesarean birth stories were not explained by changes in fear or self-efficacy.ConclusionsChildbirth preferences in nulligravid women can be significantly influenced by vicarious experiences. For stories about vaginal birth, the influence of birth stories on women’s fear and self-efficacy expectancy are partly responsible for this influence. The findings highlight the importance of monitoring bias in vicarious experiences, and may inform novel strategies to promote healthy childbirth.
Highlights
One in three women in the United States and in Australia give birth by caesarean, despite recommendations from the World Health Organisation (WHO) that a rate between 10 and 15% is optimal [1, 2]
This study investigated the effect of birth stories on childbirth preference, childbirth fear, and childbirth self-efficacy in nulligravid women, and whether childbirth fear and childbirth self-efficacy mediated changes in childbirth preference
The changes in childbirth preference significantly differed between all conditions except for between the positive vaginal and negative caesarean section birth stories, and between positive caesarean birth and negative vaginal birth stories
Summary
One in three women in the United States and in Australia give birth by caesarean, despite recommendations from the World Health Organisation (WHO) that a rate between 10 and 15% is optimal [1, 2]. Caesarean birth has undeniable benefits in high-risk pregnancies, but its over-use has adverse outcomes on physical, emotional and mental health for both mothers and babies, and avoidable increased financial costs for the healthcare system [4,5,6,7]. Maternal request for planned caesarean birth has been suggested as one explanation [10]. Women’s childbirth preferences develop before their first pregnancy, and caesarean birth preference in nulligravid (never pregnant) women already surpasses the WHO recommended rate [11,12,13,14]
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