The Effect of Group Counseling with Cognitive-Behavioral Approach on Self-Efficacy of Pregnant Women’s Choice of Vaginal Delivery

Abstract

Background: Cognitive-behavioral approach has been used to overcome many problems among pregnant women such as fear and anxiety, self-efficacy improvement, depression during pregnancy and after childbirth, traumatic childbirth, as well as stress management. Objectives: The aim of this study was to determine the effect of cognitive-behavioral group counseling approach on self-efficacy on the choice of a normal vaginal delivery. Methods: In this randomized clinical trial study, 60 nulliparous pregnant women who had not chosen their method of delivery were randomly assigned into two intervention and control groups. The intervention group received three two-hour sessions of cognitive-behavioral group counseling between the 29 and 34 weeks of pregnancy, with weekly intervals. The control group received routine care provided in the health system. Before the intervention, immediately after the end of counseling and in the last month of pregnancy, self-efficacy questionnaire, with two dimensions of expected outcomes, as well as expected self-efficacy and sources of self-efficacy (outcome of past experiences of mastering a specific situation, vicarious experience provided by others, social persuasion and physiological and affective state (fear and anxiety)) were completed with the help of a collaborating midwife. The collected data were analyzed using a mixed analysis of variance. Results: The results showed that after the intervention, 76.6% of mothers in the intervention group chose a normal vaginal delivery, however, there was no firm choice in the control group. There was a significant difference between the mean scores of expected outcome and expected self-efficacy of two groups immediately after and in the last month of the pregnancy; the difference increased with the passage of time. Conclusions: Cognitive-behavioral group counseling during prenatal care can reduce fear and anxiety and increase self-efficacy of nulliparous pregnant women in choosing normal vaginal delivery, which can ultimately reduce the amount of selective caesarean section.