Exploring the Effect of Cognitive-Behavioral Educations on Childbirth Self-efficacy, Childbirth Fear, and Adaptation of Maternal Role Among Primiparous Women: A Quasi-Experimental Study

Fatemeh Eidouzaei, Leila Amiri-Farahani, Abolfazl Mohammadi, Sally Pezaro

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Prenatal education based on a psychological approach can play a significant role in maternal and neonatal health. The current study aimed to determine the effect of cognitive-behavioral education on childbirth self-efficacy, childbirth fear, and adaption of maternal role among primiparous women. This quasi-experimental study included 74 primiparous women in the Tehran province of Iran. Convenience sampling was used to recruit participants, who were subsequently were divided into two groups (intervention and control). The intervention group received cognitive-behavioral education, held via eight 90-min-long sessions. Pre-test data collection occurred during participants’ 26–28th week of pregnancy via a survey tool comprising demographic questions, the Wijma Delivery Expectancy/Experience Questionnaire-A (W-DEQ-A), and the Child Birth Self-Efficacy Inventory (CBSEI). Post-test data collection occurred after the intervention period again via a survey tool comprising both the W-DEQ-A and CBSEI tools. The maternal role adaptation questionnaire was also completed two weeks and two months after the childbirth. After the intervention, a statistically significant difference was observed between the intervention and control groups in terms of the fear of childbirth, outcome expectancy, and self-efficacy expectancy (p < 0.05). Results demonstrated a medium effect size between the two groups in terms of the fear of childbirth score, and a large effect size in terms of both outcome expectancy and self-efficacy expectancy scores. There were no statistically significant differences between the two groups in terms of compliance with the maternal role adaptation at either 2 weeks or 2 months after the childbirth. This cognitive-behavioral educational intervention was effective in reducing fear of childbirth and improving childbirth self-efficacy. This suggests that cognitive-behavioral educations may usefully be offered to pregnant women in addition to childbirth preparation classes.
Original languageEnglish
Pages (from-to)616-633
Number of pages18
JournalJournal of Rational-Emotive & Cognitive-Behavior Therapy
Issue number3
Early online date30 Jul 2022
Publication statusPublished - Sept 2023

Bibliographical note

The final publication is available at Springer via http://dx.doi.org/ 10.1007/s10942-022-00472-0

Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.

This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.


Funding Information: This research with the research Grant No. IR.IUMS.REC.1397.346 was supported by Iran University of Medical Sciences, and with the number: IRCT20180427039436N3 was registered in the Iranian Registry of Clinical Trials (IRCT) center. The author would like to thank the Lolagar Hospital's personnel and the pregnant women who participated in this study. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • Fear of childbirth
  • Childbirth self-efficacy
  • Cognitive-behavioral educations
  • Group education
  • And maternal role adaptation


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