Effectiveness of Trainings Based on the Theory of Reasoned Action in the Choice of Natural Delivery by Pregnant Women

The prevalence of caesarian-section (C-section) has been increasing worldwide, and Iran has not been the exception (1). However, C-section is regarded as a major surgery and, similar to other major surgical procedures, is associated with side effects that sometimes can be very dangerous and rarely fatal (2). The complications of C-section are much more serious than those of normal delivery. Some of these complications include uterine infection, fever, severe wound infection and abdominal wall apoptosis, abdominal infection, bleeding, anesthesia complications, urinary tract injury during C-section delivery, blood clots in legs, increased maternal mortality, as well as higher costs than natural delivery (3,4). According to statistics, C-section deliveries account for 25.7% of all deliveries, which varies form 3.2% in Angola and 46.2% in China. The study conducted in 23 countries reported the rate of C-section for non-medical reasons between 0.01% to 2.1% (5), while according to statistics released by the World Health Organization (WHO), the rate of C-section in Iran is 41.9%, 6% of which are considered unnecessary surgical procedures (6). Factors affecting C-section are very complex, and it is very challenging to address them while evaluating the effectiveness of interventions to reduce the choice of C-section. Decisions regarding C-section are made by the mother and the physician and are influenced by a range of external factors. These decisions can be made during pregnancy and even before labor and can be due to medical (for mother and baby) or psychosocial reasons (7). Qualitative studies have shown that pregnant women’s improper attitudes, perceived behavioral control, and poor subjective norms during the third trimester of pregnancy are the factors that influence the choice of C-section (8,9). Addressing the factors that affect mothers’ choice and decision regarding the type of delivery seems essential. Various studies have emphasized teaching the skills necessary for pregnant women and their partners to choose a suitable delivery method (8-10). Therefore, guidance and training for pregnant women can reduce the rate of unnecessary C-section deliveries, enabling mothers to acquire the necessary knowledge to Abstract Objectives: Due to the high rate of caesarian-section (C-section) in Iran, the aim of this research was to design and implement interventions based on the theory of reasoned action in pregnant women to promote the choice of natural delivery. Materials and Methods: This quasi-experimental intervention was performed in Abhar, Iran on 200 pregnant women in the two groups of intervention and control. Data were collected, using a questionnaire designed by the researcher, before and after the intervention. Validity and reliability of the questionnaire were confirmed. The single-stage random cluster sampling was used. Data were analyzed using IBM SPSS Statistics 23 and statistical tests such as analysis of variance (ANOVA), Pearson correlation coefficient, t test, regression, and logistic regression. Results: Paired t test showed a significant difference in the mean scores of constructs of theory of reasoned action before and after training in the intervention group; however, no statistically significant difference was observed in the control group in terms of mean scores of constructs of theory of reasoned action. Logistic regression showed that, before training, none of the reasoned action constructs predicted natural delivery in the intervention group; however, in the intervention group after training, normative beliefs, motivations to comply and behavioral intention predicted natural delivery. The same test showed that only motivations to comply predicted natural delivery in the control group before and after training. Conclusions: It can be concluded that the theory of reasoned action can be effective in creating and enhancing pregnant women’s choice of natural delivery. Therefore, considering that rate of C-section is increasing in Iran, this theory can be a useful tool for designing and implementing educational interventions aimed at improving the choice of natural delivery by pregnant women.