Pregnancy is a natural and important physiological phenomena and event in woman‘s life which could change many views of a woman about life.1,2 Annually, many women become pregnant worldwide; however, pregnancy and childbirth is not a pleasant event for all them; in fact, more than 90% of maternal anxiety could be related to the delivery process.3 In addition, childbirth is a natural process which has its own preventive measures and support.4
Nowadays, the increased rate of unnecessary cesarean is a public health challenge around the world. According to a survey conducted by WHO in 2010, 25.7 percent of all deliveries was performed to cesarean worldwide.5 In fact, according to WHO reports, the rate of cesarean has increased from 35% in 2004 to 50-65% in 2009 in Iran.6 It should be noted that sometimes due to medical indications and also in order to avoid of the potential hazards which may threaten the life of mother and baby, cesarean delivery is vital. However, another concern is the increasing of uncontrolled inessential cesarean.7
Several studies have suggested different indications for cesarean section which could be divided to two factors: individual and social factors. The individual factors include Mother's fear of labor pains, mothers’ desire to perform cesarean, lack of awareness of the complications of cesarean, negative attitude to labor and previous cesarean.8-11 Moreover, the social factors may consist of increasing marriage age, higher age of women at first pregnancy, lack of cooperation insurance organizations to support the natural childbirth.12,13
The unnecessary cesarean delivery has an important impact on maternal and neonatal health; and reduction of (unessential) caesarean section is one of the health priorities; that’s why many countries are trying to reduce dispensable cesarean and promote natural childbirth. Nowadays, in most developed countries, using new policies of mother and child health, through a lot of interventions which tend to reduce the cesarean rate is common. For example, in 1990 in USA, through a successful strategy of the influence on medical doctors and making changes in their motivations for cesarean delivery, the incidence of cesarean section was dropped from 13.5% to 6.5%.14
Maternal Health Office at Iranian Ministry of Health and Medical Education in 2002, initiated the design of a national program for establishing of mother-friendly hospitals in order to reduce the cesarean rate by 25 % until 2015.15 In addition, previous research has shown that through education of mothers and reducing their fear about childbirth and correcting some wrong beliefs about natural childbirth the unnecessary cesarean section could be reduced.14 Furthermore, some of the individual factors such as maternal fear of childbirth, the willingness of pregnant women to perform cesarean, lack of awareness of side effects of cesarean and the negative attitudes towards vaginal delivery are modifiable by implementing educational interventions.
We conducted a study to evaluate the impact of educational intervention on self-efficacy in reducing elective caesarean section on 130 pregnant women with gestational age of 27.22±5.23 weeks, referring to health care centers of Shahrekord city which were located in southwest of Iran.16 In our interventional study, pregnant women were divided into two groups. Mothers in intervention group, in addition to receive the routine prenatal care, participated in educational sessions, based on strategies for increasing self-efficacy (Performance Accomplishment, Vicarious Experience, Verbal Persuasion and Emotional/ Physiological arousal). Mothers in control group have only received the routine care during pregnancy. We found that with increasing self-efficacy and reducing the fear of childbirth in pregnant women can be reduced in elective cesarean.
In conclusion, the effectiveness of theory-based and systematic training on the control of fear and anxiety in pregnant women as well as regular training could lead to increase understanding of mothers’ belief on their own potential ability to have natural childbirth instead of cesarean section. Moreover, their self-efficacy and confidence could increase and in turn leads to a reduction in their request for cesarean section.