Childbirth Self-efficacy Research Articles

Skills-based childbirth preparation increases childbirth self-efficacy for first time mothers

ObjectiveTo explore the potential benefits of skills-based childbirth preparation on first time mother's childbirth self-efficacy. DesignAn RCT of an education programme for skills-based childbirth preparation was conducted. Data were examined for significant differences between groups over time and at outcome. SettingFirst time New Zealand mothers completed the requirements of the study in the privacy of their own homes. ParticipantsOne hundred and eighty-two first time mothers who self-selected met eligibility and were recruited to the study. Of these 137 completed the study (75% retention rate). InterventionAn anonymised version of The Pink Kit Method for Birthing Better® (CKT, 2001), a multi-media, skills-based and self-directed childbirth preparation programme. The course includes: breathing exercises, verbal and non-verbal communication exercises, tension reducing exercises, and body exercises as well as advice about stages, delivery methods, and when to use the skills. Measurementsthe Childbirth Self-Efficacy Inventory (Scale) (CBSEI), New Zealand Adaptation (Lowe, 1993) at 24 weeks and 36 weeks gestation. FindingsThere were no differences between groups in childbirth self-efficacy at the baseline measurement at 24 weeks gestation. At 36 weeks gestation the Intervention Group showed a significant increase in childbirth self-efficacy. The Intervention Group self-efficacy score was also statistically different from each of the control groups at 36 weeks gestation. Key conclusionsA skills-based self-directed childbirth preparation programme was able to increase childbirth self-efficacy in a sample of first time mothers. Implicationsfor practice: Women might be encouraged to participate in these types of skills-based programmes to aid childbirth.

Experience of Childbirth With Birth Ball: A Randomized Controlled Trial

Objectives: Childbearing is considered as a great event in the lives of many women while the effect of pain on this event is undeniable. Thus, the think of pain and how to overcome it has engaged the minds of women, their family, and health-care providers. The birth ball is one of the non-invasive methods of pain control. Therefore, the present study aimed to evaluate the effect of the birth ball on the pain and self-efficacy of pregnant women during the childbirth process. Materials and Methods: This study was a randomized clinical trial. A total of 178 participants were selected based on the specific selection criteria and randomly allocated to control and intervention groups. The women in the intervention group were asked to join a planned exercise with the birth ball including a 20-minute well-defined exercise three times a week for 6–8 weeks at home whereas those in the control group followed up the routine prenatal cares. The questionnaires were completed by the participants at the four and eight-centimeter cervical dilations. Results: Based on the results, birth ball exercises could significantly improve childbirth self-efficacy and pain so that labour pain was lower in this group of women as compared to the other group (P<0.001 in both cervical dilatations). In addition, the score of selfefficacy was higher in the intervention group compared to the control group (P<0.001). Further, the result of generalized estimating equation model showed that birth ball exercise can decrease the childbirth pain. However, part of this effect may be related to an increase in the patients’ self-efficacy (30%-40%). Conclusions: In general, although birth ball exercise could decrease the childbirth pain, part of this effect was probably associated with an increase in self-efficacy of the patients.

Risky, Dramatic, and Unrealistic: Reality Television Portrayals of Pregnancy and Childbirth and their Effects on Women’s Fear and Self-Efficacy

ABSTRACTBecause portrayals of pregnancy and childbirth on reality television (TV) often highlight risk, drama, and the use of medical interventions, it is possible that exposure to this content could influence women’s fear of childbirth and childbirth self-efficacy. To test this question, we conducted an experiment among 213 undergraduate women who were assigned to view a video clip of either medicalized births from reality TV, midwife-attended births from reality TV, or a neutral childbirth education clip. Findings indicated that childbirth attitudes did vary across conditions, with participants in the medicalized condition reporting the highest fear of childbirth and lowest childbirth self-efficacy. Participants’ feelings about potential pregnancy also varied depending on the clip viewed. Because the likelihood of witnessing a birth in person before becoming pregnant is lower than in previous years, these findings have significant implications for how women form their understandings of pregnancy and childbirth.

Mindfulness-based programme on the psychological health of pregnant women

ProblemPreparation of psychological well-being is an important component of antenatal education for childbirth, but few courses focus on this component. BackgroundThe psychosocial health of pregnant women is known to affect perinatal outcomes. Psychosocial stress in women has been associated with increased obstetric interventions and has been shown to affect the health of both mother and child. AimTo explore the efficacy of an eight-week Mindfulness-Based Childbirth and Parenting programme on reducing prenatal stress, depression, mindfulness, and childbirth self-efficacy. MethodsIn this prospective and randomized controlled trial study, 104 women between 13 and 28 weeks gestation were enrolled and assigned randomly into two groups. Participants in the experimental group received mindfulness-based programme and practice-at-home with audio recordings. The comparison group received traditional education classes. Psychological health was assessed at baseline, post-intervention, and 36-week gestation. FindingsSignificant differences were seen in both groups in terms of changes over time in stress, depression, childbirth self-efficacy, and mindfulness, as compared with baseline. In gestation week 36, stress scores were slightly higher and childbirth self-efficacy and mindfulness scores were lower for both groups, but all scores were relatively better in the experimental than in the comparison group. ConclusionsPerinatal mental health problems affect mothers, their infants, and society. The eight-week mindfulness programme effectively reduced self-perceived stress and depression and increased childbirth self-efficacy and mindfulness. Future research is needed to explore the potential benefits, mechanisms, and effects on maternal and infant birth outcomes of mindfulness.

Relaxation techniques for pain management in labour.

Relaxation techniques for pain management in labour.

Factors associated with Chinese nulliparous women's choices of mode of delivery: A longitudinal study

BackgroundCaesarean section rates have risen beyond the WHO recommended level in many countries worldwide. An emerging epidemic in caesareans has appeared in China over the past two decades, mainly driven by non-medical factors. China's one-child policy was previously seen as a potential factor for contributing to women's high caesarean section rates. The Chinese government has officially announced a two-child policy in recent years, causing numerous families to reshape their fertility intentions and birth preferences. There have been few studies focusing on women's expected and actual delivery mode and the associated factors affecting their choices of mode of delivery. ObjectiveTo investigate nulliparous women's expected and actual mode of delivery, and the related factors associated with delivery mode in the context of China's two-child policy. Design, settings, and participantsThis longitudinal study approached 1368 pregnant women who attended the antenatal clinic regularly at a tertiary specialized women's hospital in Shanghai, China. Among the 1368 women, 1211 agreed to participate and were investigated at admission of this study. MethodsData were collected via questionnaires using Birth Attitude Questionnaire (BAQ), Subjective Norm Questionnaire (SNQ), and Childbirth Self-Efficacy Scale (CSES). Descriptive statistics and logistic regression analyses were used. ResultsOf 1211 participants, the number of women expecting a vaginal delivery at three pregnancy stages accounted for 74%, 78%, and 83%, respectively. Finally 48% (520/1084) ended up having a caesarean delivery. Caesarean section for lack of medical indications accounted for 57% (297/520). Among women who met the requirements of two-child policy, 39% planned to have a second child. In logistic regression analyses, participants with stronger expectations of caesarean deliveries during late pregnancy (aOR, 35.18; 95% CI, 12.66–97.74), having higher scores of birth attitude toward CS (aOR, 1.13; 95% CI, 1.06–1.20), and with lower scores of intrapartum childbirth self-efficacy (aOR, 0.85; 95% CI, 0.77–0.92) had significantly higher odds of having an actual caesarean delivery. ConclusionsDuring the initial period of China's two-child policy, the majority of women value vaginal delivery whereas high caesarean section rate still becomes a great concern in current China. Individual preferences, birth attitude, and childbirth self-efficacy are altogether associated with women's different choices of mode of delivery.

A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy

ObjectiveTo explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy. DesignQualitative descriptive design with in-depth semi-structured interviews. SettingPostnatal wards at a tertiary specialized women's hospital in Shanghai, China. Participants21 nulliparous women 2–3 days postpartum were purposively sampled until data saturation. MethodsIn-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016. ResultsTwo overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, ‘shy away’ and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, ‘shy away’ and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment. Conclusion and implications for practiceAt the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them.

On the relation of self-efficacy and coping with the experience of childbirth

Objective: To analyze the relationship between self-efficacy expectancies, the use of coping behavior strategies during labor and satisfaction after childbirth.Methods: A quantitative observational design was applied as part of a correlational study conducted in the maternity unit of a Hospital Complex that welcomes nearly 4,000 births each year at Vigo, Spain, between 2014 and 2015. A total of 276 low-risk pregnant women were recruited to undertake a self-assessment of their childbirth experience at two stages: within the last three months of pregnancy and within two weeks after labor. Data were collected through the Childbirth Self-Efficacy Inventory to measure self-efficacy expectancies as well as coping, along with a 6 items, 10-point Likert scale to measure satisfaction after childbirth.Results and conclusions: Pearson product-moment correlation supported the positive association of self-efficacy expectancies scores with coping during labor. Multivariate regression analysis also revealed gains in satisfaction after childbirth associated with coping during labor. Women with larger scores in self-efficacy were found to use coping strategies during labor, had a more positive evaluation of the childbirth experience and showed significant gains in satisfaction after childbirth. The study supports the efforts of healthcare professionals to increase satisfaction with the childbirth experience by helping to enhance self-efficacy and coping in pregnant women.

The effect of religious-spiritual support on childbirth self-efficacy.

BACKGROUND:Childbirth self-efficacy is one of the most important factors causing a shift in mothers do vaginal delivery. If the mother feels that she can cope well with stress, will be protected from the harmful effects of stress on your health. Self-efficacy contained individual's assessment of her ability to deal with stressful situations. Strengthen the spiritual beliefs of the patient causes her to be a good result every situation even incurable condition. This study aimed to determine the effect of religious-spiritual support on childbirth self-efficacy in primiparous women.METHODS:This is a quasi-experimental study carried on seventy primiparous women; participants were randomly divided into two intervention and control groups. The intervention group received the e-learning package based on religious-spiritual content. Self-efficacy questionnaire by both groups before and 4 weeks after it was completed. Collected data were entered into SPSS version 11 descriptive statistics, independent t-test, and paired t-test which were used for analysis of data. The significant level was considered <0.05.RESULTS:The results showed that the mean self-efficacy score before and after intervention in case group was 105.2 (27.01) and 110.12 (21.2), respectively, and in control group; 111.2 (23.12) and 116.9 (24.43). Paired t-test in two groups was significant (P = 0.042, P = 0.045) but independent t-test showed no significant difference in scores of childbirth self-efficacy before and after intervention in two groups (P = 0.061).CONCLUSION:In prenatal periods, religious-spiritual support through electronic package method can increase childbirth self-efficacy, so the planning and establishment of this training are recommended as an effective training.

The Relationship of Attachment Styles with Childbirth Self-efficacy in Nulliparous Pregnant Women: The Mediating Role of Alexithymia

Background & aim: The enhancement of childbirth self-efficacy to manage the labor pain can help the nulliparous pregnant women to make informed choice about vaginal delivery. Regarding the relationship of the childbirth self-efficacy with psychological antecedents, the present study aimed to explore the meditating role of alexithymia in the relationship of attachment styles and childbirth self-efficacy among the nulliparous pregnant women. Methods: This descriptive correlational study was conducted on 210 nulliparous pregnant women, living in Shiraz in 2016. The samples were selected from the nulliparous women referring to the public and private health and medical centers through the purposive sampling technique. The data were collected using a researcher-made demographic form, Iranian version of Childbirth Self-Efficacy Inventory, Hazan and Shaver’s Adult Attachment Inventory, and Farsi Toronto Alexithymia Scale-20. The data analysis was performed using the descriptive statistics and structural equation modeling through the SPSS version 20 and AMOS version 21, respectively. Results: Our findings indicated that all aspects of attachment styles (i.e., secure, avoidant, and ambivalent) would be able to predict the childbirth self-efficacy in the nulliparous pregnant women. On the other hand, the secure and insecure attachment styles predicted alexithymia among this population. The results of the path analysis demonstrated that alexithymia had a mediating role in the relationship of the attachment styles and the childbirth self-efficacy. Conclusion: Based on the findings of the present study, it can be concluded that the attachment styles and childbirth self-efficacy had an indirect relationship mediating through such variables as alexithymia.

Antenatal Education on Childbirth Self-Efficacy for Egyptian Primiparous Women: A Randomized Control Trial

Antenatal Education on Childbirth Self-Efficacy for Egyptian Primiparous Women: A Randomized Control Trial

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

BackgroundChildbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education.MethodsThis study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected.ResultsIn a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls.ConclusionsThis study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects.Trial registrationThe ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559. The study was retrospectively registered on June 23, 2014.

Skills-based childbirth preparation reduces stress for midwives

Objectiveto explore the potential benefits of skills-based childbirth preparation on the work related stress levels of midwives. Designa questionnaire was sent out to midwives who had clients participating in an RCT of an education package for childbirth preparation (The Pink Kit (PK) Method for Birthing Better®) delivered to parents. Settingmidwives were in private practice and acted as lead maternity carers to New Zealand first time mothers. Participantsone hundred and four independent midwives participated. Measurementsa brief questionnaire using a Visual Analogue Scale to portray perceptions of work-related stress and a yes/no question about expected and/or unexpected physical complications. Findingsmidwives working with clients in the intervention group experienced less work-related stress after correction for medical complications compared to the two control groups. Key conclusionsworking with mothers who have used a programme that increased their childbirth self-efficacy decreased the work-related stress experienced by midwives. Implications for practiceencouraging pregnant women to develop childbirth skills merits further investigation in an effort to reduce the work-related stress experienced by midwives.

The Effect of Antenatal Class Plus Coping Skill Training on the Level of Stress and Childbirth Self-Efficacy

Background: Pregnancy puts mothers in vulnerable conditions that lead to stress. Consequently, a negative impact over the stress influences mother’s and baby’s health. Antenatal class (AC) was aimed to increase knowledge and prepare for childbirth. However, AC focuses on delivering knowledge, whereas the content is lack of psychological preparation such as developing self-efficacy and coping skill in facing childbirth. This study aimed to find the effect of antenatal class plus coping skills training towards a level of stress, and a childbirth self-efficacy. Method: This study was a randomized pre-test post-test control group design over primigravida women in their 24–34 weeks of Deliveredpregnancy. DatabyIngentacollectionto:wasDianconductedSawitriin 4 weeks. Data were analyzed using paired T-test and independentIP:36.80.134T-test,.221andOn:alsoTue,repeated08 AugANOVA2017with16:17:43Benferroni post hoc test. Results: The mean age of participantsCopyright:was24yearsAmerican.TheinterventionScientificof antenatalPublishersclass plus coping skills training had significant influence to decrease the stress level (p = 0 014) between groups. In one hand, it was also enhancing the childbirth self-efficacy but in the other hand it was statistically insignificant with the mean and standard deviation of 2.484 and 12.727 respectively, with a p value of 0.579 between the groups. Conclusion: It is essential for pregnant women to have antenatal classes plus coping skills training. It is also important to screen the pregnant women for stress and the screen protocol could be included in the maternal handbook. Keywords: Coping Skill Training, Childbirth Self-Efficacy, Antenatal Class, Stress Levels.

Correlation between the fear related to childbirth and the social support in pregnant women

Objective To investigate correlation between the fear related to childbirth and the social support in pregnant women in order to provide evidence for clinical intervention. Methods A total of 351 pregnant women from 2 hospitals were recruited from July to December, 2014 in city of Guangzhou. They were investigated with the self-designed questionnaire of general conditions measurement, the childbirth Attitudes Questionnaires and the perceived Social Support Scale. Results The total scores of the fear related to childbirth and the social support in pregnant women were 32.29±6.25 and 46.59±7.13, respectively. Scores of the total scale and the factors of the fear related to childbirth and the social support were negatively correlated (r=-0.798- -0.134, P < 0.05). Conclusions Negative correlation exists between the fear related to childbirth and the childbirth self-efficacy in pregnant women. To reduce the fear related to childbirth, their families should be encouraged to provide more support for pregnant women. Key words: Pregnant women; Social support; Fear related to childbirth

Comparing the effect of e-learning and educational booklet on the childbirth self-efficacy: a randomized controlled clinical trial

Purpose: This study aimed to compare the effect of e-learning and educational booklet on the childbirth self-efficacy (CBSE).Methods: This randomized controlled clinical trial was conducted on 153 pregnant women referred to health centers in the city of Miandoab, Iran in 2015–2016. Participants were assigned into two intervention groups (e-learning and educational booklet) and the control group. A single face-to-face session was held for intervention groups about the management of labor pain in 30–34 weeks of pregnancy and the booklet and software were provided. The CBSE questionnaire was filled out by the participants before intervention and active phase of labor at 4–5 cm dilatation of cervix. One-way ANOVA and ANCOVA test with adjusting the baseline scores were used to compare the mean score of self-efficacy among study groups respectively before and after the intervention.Results: There was no significant difference between the three groups in terms of socio-demographic characteristics (p > 0.05). After the intervention, the mean score of the CBSE in the educational booklet group (adjusted mean difference: 113.4; confidence interval 95%: 100.7–126.1) and e-learning group (159.3; 146.5–172.0) was significantly higher than the control group. Also, the mean score of the CBSE in the e-learning group had a significant increase compared to the educational booklet group (45.9; 33.0–58.7).Conclusions: The results indicate that e-learning and educational booklet are effective in enhancing mothers' CBSE. Thus, the mothers are recommended to use these teaching methods.

The effects of mindfulness interventions on prenatal well-being: A systematic review

Objective: Low well-being during pregnancy can have significant adverse outcomes for mother and child. The effects of mindfulness interventions on prenatal maternal well-being are increasingly examined but outcomes have yet to be systematically evaluated. The aims of the current paper are to systematically evaluate intervention effects and current research approaches with pregnant groups.Design: A systematic review of eight studies examining mindfulness intervention effects on prenatal well-being.Results: Findings indicate potential benefits of mindfulness interventions for reducing levels of depression, anxiety and negative affect during pregnancy. There is also evidence for improved self-compassion and perceived childbirth self-efficacy. Further, these effects may be more pronounced for vulnerable groups, such as women currently experiencing low prenatal well-being. Less consistent findings were observed for stress, and positive affect. Variations in research design, gestational characteristics, timing of assessments and outcome measurement may explain some inconsistencies in the extant literature.Conclusion: Mindfulness interventions present a potentially useful means to improve prenatal well-being but improved methodological quality is essential to rigorously examine intervention effects.

Risk factors associated with post-traumatic stress symptoms following childbirth in Turkey

Objectivethis study examined factors associated with symptoms of post-traumatic stress (PTS) following childbirth in women with normal, low-risk pregnancies in Nigde, Turkey. Designa prospective longitudinal design where women completed questionnaire measures at 20+ weeks’ gestation and 6–8 weeks after birth. Settingeligible pregnant women were recruited from nine family healthcare centres in Nigde between September 2013 and July 2014. Participantsa total of 242 women completed questionnaires at both time points. MeasuresPTS symptoms were measured using the Impact of Event Scale-Revised (IES-R) 6–8 weeks after birth. Potential protective or risk factors of childbirth self-efficacy, fear of childbirth, adaptation to pregnancy/motherhood, and perceived social support were measured in pregnancy and after birth. Perceived support and control during birth was measured after birth. Demographic and obstetric information was collected in pregnancy using standard self-report questions. FindingsPTS symptoms were associated with being multiparous, having a planned pregnancy, poor psychological adaptation to pregnancy, higher outcome expectancy but lower efficacy expectancy during pregnancy, urinary catheterization during labour, less support and perceived control in birth, less satisfaction with hospital care, poor psychological adaptation to motherhood and increased fear of birth post partum. Regression analyses showed the strongest correlates of PTS symptoms were high outcome and low efficacy expectancies in pregnancy, urinary catheterization in labour, poor psychological adaptation to motherhood and increased fear of birth post partum. This model accounted for 29% of the variance in PTS symptoms. Conclusionsthis study suggests women in this province in Turkey report PTS symptoms after birth and this is associated with childbirth self-efficacy in pregnancy, birth factors, and poor adaptation to motherhood and increased fear of birth post partum. Implications for practicematernity care services in Turkey need to recognise the potential impact of birth experiences on women's mental health and adaptation after birth. The importance of self-efficacy in pregnancy suggests antenatal education or support may protect women against developing post partum PTS, but this needs to be examined further.

The effects of antenatal education on fear of childbirth, maternal self-efficacy and post-traumatic stress disorder (PTSD) symptoms following childbirth: an experimental study

BackgroundFear of birth and low childbirth self-efficacy is predictive of post-traumatic stress disorder symptoms following childbirth. The efficacy of antenatal education classes on fear of birth and childbirth self-efficacy has been supported; however, the effectiveness of antenatal classes on post-traumatic stress disorder symptoms after childbirth has received relatively little research attention. PurposeThis study examined the effects of antenatal education on fear of childbirth, maternal self-efficacy and post-traumatic stress disorder symptoms following childbirth. DesignQuasi-experimental study. MethodsThe study was conducted in a city located in the Middle Anatolia region of Turkey and data were collected between December 2013 and May 2015. Two groups of women were compared—an antenatal education intervention group (n=44), and a routine prenatal care control group (n=46). The Wijma Delivery Expectancy/Experience Questionnaire, Version A and B, Childbirth Self-efficacy Inventory and Impact of Event Scale–Revised was used to assess fear of childbirth, maternal self-efficacy and PTSD symptoms following childbirth. ResultsCompared to the control group, women who attended antenatal education had greater childbirth self-efficacy, greater perceived support and control in birth, and less fear of birth and post-traumatic stress disorder symptoms following childbirth (all comparisons, p<0.05). ConclusionsAntenatal education appears to alleviate post-traumatic stress disorder symptoms after childbirth.

Antenatal education in small classes may increase childbirth self-efficacy: Results from a Danish randomised trial

Antenatal education in small classes may increase childbirth self-efficacy. In this randomised trial we assessed the effect of a structured antenatal programme versus auditorium-based lectures on childbirth self-efficacy measured by three single items. We found that women in the intervention group reported statistically significant higher levels of confidence in their ability to cope at home during labour compared to the control group. Likewise, the intervention had a positive effect on the women's confidence in own ability to handle the birth process.