Abstract
Background & Objectives: Pregnancy and childbirth are part of the natural and evolutionary process in women. However, little attention has been paid to the psychological aspects of pregnant women, and fear of childbirth is considered one of the fundamental issues of pregnancy. Psychological and social factors affecting fear of childbirth, including fear of the unknown, desire for pain relief, physical and mental relaxation, and concern for the health of the newborn, highlight the need for psychological education, which plays a significant role in reducing mental illnesses and disorders and anxiety, as well as improving the physical and mental health of pregnant mothers, especially in mothers who are afraid of the childbirth process. One of these approaches is behavioral activation therapy. Another very effective way to cope with stress and labor pain is to use body relaxation. There are several psychological factors involved in fear of childbirth that, if not addressed and treated, may lead to posttraumatic stress disorder in the future. Therefore, the present study was conducted to compare the effectiveness of behavioral activation and body relaxation on fear of childbirth and choice of childbirth type in primiparous women.
Methods: The research method was quasi-experimental, with a pretest-posttest design and a control group. The statistical population consisted of primiparous pregnant women who referred to clinics in Karaj City (Iran) for prenatal care in 2021. The sample size was determined to be 135 people using G*Power software, with a 95% confidence interval and 90% test power, based on the formula for two-sided tests. Due to the specific conditions of pregnant women and the possibility of sample loss, and to increase the validity and generalizability of the results, 48 participants were included in each group. So, 144 qualified volunteers were selected using a convenience sampling method and randomly assigned to 2 experimental groups and 1 control group. The inclusion criteria were first birth (first child), aged 20 to 35 years, gestational age between 30 and 34 weeks, at least a diploma education, no drug use, and no physical or mental illnesses according to medical records and clinical interview. The exclusion criteria for leaving the research were: absence of more than 2 sessions, abortion, and the presence of distorted questionnaires. To collect data, we used the Attitude Towards Childbirth Questionnaire (Lowe, 2000) to measure fear of childbirth. Also, due to the lack of access to a valid test to measure pregnant women's choice of childbirth method, women were asked in the demographic information form to indicate their preferred childbirth method from two options: "natural birth" and "cesarean section." The first experimental group received behavioral activation in 8 90-min sessions, and the second experimental group received body relaxation in 6 90-min sessions; the control group did not receive psychological intervention until the end of the research. To comply with ethical principles in the matter of education, at the end of the work, the control group was included among the project participants, and therapeutic intervention was also implemented on them. After collecting the data, univariate covariance analysis, Bonferroni post hoc test, and McNemar test were used to analyze the data at a significance level of 0.05 using SPSS version 24.
Results: Behavioral activation (p<0.001) and body relaxation (p=0.002) reduced fear of childbirth compared with the control group. Also, behavioral activation was more effective than body relaxation in reducing fear of childbirth and increasing the choice of natural childbirth in primiparous women (p<0.001).
Conclusion: Based on the research results, behavioral activation intervention is more effective compared to body relaxation. As a result, behavioral activation intervention can be used to reduce the fear of childbirth and improve the attitude towards choosing the type of childbirth in primiparous women.