Application Of Prenatal Education Based On Self-Determination Theory In Pregnant Women With Fear Of Childbirth

Objective:1.To understand the current state of fear of childbirth in pregnant women and its influencing factors.2.Understanding the true experience of the inner fear of childbirth in pregnant women.3.To construct a prenatal education program for fear of childbirth among pregnant women based on self-determination theory and to initially validate the effectiveness of the intervention.Methods:1.A convenience sampling method was used to select 554 pregnant women in three tertiary hospitals in Yangzhou City from October 2021 to February 2022 as respondents,using general information and the Obstetric Characteristics Questionnaire,Childbirth Attitude Questionnaire(CAQ),Basic Psychological Needs Scales(BPNS),and Conner-Davidson Psychological Resilience Scale(CD-RISC).This study described the current situation of fear of childbirth among pregnant women and used multiple linear regression to analyses the factors influencing the fear of childbirth among pregnant women.2.A purpose sampling method was used to select 13 pregnant women who gave birth in three tertiary hospitals in Yangzhou City from February to May 2022,and they were interviewed in a semi-structured manner using phenomenological analysis in qualitative research,and the interview data were analyzed using the Colaizzi 7-step phenomenological analysis.3.In this part,based on the literature review,cross-sectional survey,and qualitative study,a prenatal education program for pregnant women with fear of childbirth based on self-determination theory was constructed through group discussion and expert correspondence method and passed preliminary validation.Pregnant women with fear of childbirth who met the inclusion and exclusion criteria and were routinely examined at Subei People’s Hospital in Jiangsu Province from August to November 2022 were randomly divided into a control group and an intervention group using the lottery method,with the control group receiving routine care and the intervention group implementing the self-determination theory-based prenatal education program for pregnant women with fear of childbirth based on the control group.The fear of childbirth,the level of basic psychological needs satisfaction,the level of resilience,and the rates of caesarean section and perineal injury in the two groups were compared before and after the 4-week intervention respectively.Results:1.The results of the cross-sectional survey showed that the CAQ score for pregnant women was 16 to 64(33.56±10.05),the BPNS score was 42 to 147(104.04±16.24)and the CD-RISC score was 28 to 100(76.35±15.12)points.Maternal BPNS scores(r=-0.476,P<0.05)and CD-RISC scores(r=-0.410,P<0.05)were negatively correlated with CAQ scores.Social support status(minimal social support as a reference,general social support t=-4.819,P<0.001,full social support t=-7.195,P<0.001),mode of conception(natural pregnancy as a reference,assisted reproductive technology t=6.556,P<0.001),whether the pregnancy was planned(planned pregnancy as a reference,unplanned pregnancy t=2.035,P=0.042),experience of childbirth(first-time mothers as a reference,previous natural birth t=-3.211,P=0.001,previous elective caesarean t=-5.013,P<0.001,previous emergency caesarean t=-2.872,P=0.004),intention to have another child(no intention to have another child as a reference,intention to have another child t=-4.286,P<0.001),BPNS score(t=-5.026,P<0.001)and CD-RISC score(t=-4.257,P<0.001)were the influencing factors for maternal fear of childbirth.2.The qualitative part of the study identified four themes:low participation in birth planning and low sense of self-control during labor,which reduced the need for maternal autonomy;lack of knowledge about labor and low self-efficacy in labor,which reduced the need for competence;lack of support from medical staff,family and peers,which reduced the need for relatedness;and co-existence of positive and negative coping.3.After 4 weeks of self-determination theory-based prenatal education on the fear of childbirth for pregnant women,the total CAQ score and the scores on each dimension of the intervention group decreased significantly(P<0.05),and the total BPNS and CD-RISC scores and the scores on each dimension of the intervention group increased significantly(P<0.05);the total CAQ,BPNS,and CD-RISC scores and the scores on each dimension of the control group did not change significantly(P>0.05).The results showed that after the intervention,the total score of CAQ and the scores of each dimension were significantly lower in the intervention group than in the control group(P<0.05),the total score of BPNS and CD-RISC and the scores of each dimension were significantly higher than in the control group(P<0.05),and the caesarean section rate was significantly lower in the intervention group than in the control group(P=0.044),while the perineal injury rate did not differ significantly between groups(P=0.730).Conclusion:1.The prevalence of fear of childbirth in pregnant women was high.Social support,mode of conception,whether the pregnancy was planned,childbirth experience,intention to have another child,BPNS score,and CD-RISC score were factors influencing fear of childbirth in pregnant women,and health professionals should pay attention to screening for fear of childbirth in pregnant women to effectively identify high-risk factors and develop targeted interventions.2.Medical staff should promote pregnant women’s participation in birth planning,reduce the sense of loss of control in labor and enhance the satisfaction of autonomy needs;provide multiple forms of information support,enhance self-efficacy in labor,and promote the satisfaction of competence needs;promote multiple social support and enhance the satisfaction of relatedness needs;improve negative coping strategies,enhance the satisfaction of basic psychological needs and promote perinatal mental health.3.The self-determination theory-based prenatal education program for fear of childbirth reduced the level of fear of childbirth,increased the level of basic psychological needs satisfaction and psychological resilience of pregnant women,and reduced the rate of caesarean section delivery.The results provide a reference and basis for clinical staff to intervene with fear of childbirth.