The Effect of Prenatal Yoga-Assisted Birth Preparation Training on Fear of Childbirth and Childbirth Self-Efficacy

The Effect of Online Prenatal Yoga-Assisted Birth Preparation Training Based on Albert Bandura's Self-Efficacy Theory on Fear of Childbirth and Childbirth Self-Efficacy in Primiparas: Randomized Controlled Study

Pregnancy is a life event that requires biopsychosocial adaptation. Although pregnancy is often perceived as a positive and physiological process, women experience a wide range of fears of childbirth, from simple anxiety to severe phobic fear (tokophobia), during their pregnancy. It is thought that the feeling of experiencing pain often lies at the root of the fear of childbirth. However, fear of childbirth can be experienced for many different reasons depending on biological, psychological and sociocultural factors, personal characteristics and experiences. The prevalence of fear of childbirth in the world is 14%. In Turkey, the prevalence of fear of childbirth varies between 16% and 69%, and 21% of women experience fear of childbirth at a clinical level. In general, fear is a physiological reaction that is important for the safety of the individual, and it is thought that low-level fear of childbirth will prepare individuals for parenting. However, uncontrollable fear of childbirth can lead to physical, emotional and behavioural changes that negatively affect the woman's daily life, prolonged labour and childbirth complications. Most importantly, women who cannot cope with the fear of childbirth may perceive cesarean section as the only solution and turn to elective cesarean section. The total cesarean section rate in Turkey is 52%, which is much higher than the World Health Organization's acceptable cesarean section rate. Fear of childbirth has been accepted as an important public health problem that needs intervention both in the world and in our country, and research on fear of childbirth has accelerated, especially in the last twenty years.

Although there are many factors affecting fear of childbirth, childbirth self-efficacy is among the important predictors of fear of childbirth. Albert Bandura defines self-efficacy as "an individual's belief in his or her ability to engage in behaviour that leads to the desired outcome in a given situation." Bandura divided self-efficacy into two subcomponents, efficacy and outcome expectancy, and tried to explain human behaviour in this way. While efficacy expectancy describes the individual's belief that they can perform certain behaviours successfully (e.g., the woman's belief that she can successfully perform relaxation exercises during labour), outcome expectancy refers to the belief that performing a behaviour will lead to a result. (e.g., the woman's belief that she will experience less pain if she relaxes during labour). Self-efficacy is important in determining the direction of emotions, thoughts and behaviour patterns. For this reason, the "concept of birth self-efficacy" has been defined separately. Childbirth self-efficacy refers to the woman's self-confidence in coping with labour. Women with higher self-efficacy expectations are more likely to initiate and maintain pain-coping strategies. High childbirth self-efficacy is associated with improved perinatal outcomes and maternal health. A woman's self-confidence increases her access to methods of coping with labour and her ability to cope with the fear of birth. For this reason, it is important to associate the resources that nourish the concept of self-efficacy with childbirth. For this reason, Lowe associated self-efficacy resources with childbirth.Prenatal education is accepted as an effective strategy to improve women's self-efficacy during pregnancy. Prenatal education enables expectant mothers to make safe decisions during pregnancy and birth, improves their skills in coping with labour pain, increases birth self-efficacy and reduces the fear of birth. There are also study results showing that prenatal education can affect the type of birth, the use of birth-related interventions, and obstetric outcomes. It is especially important in terms of reducing the rate of interventional childbirth and cesarean sections. In recent years, yoga has been one of the preferred practices in the prenatal period due to its positive physical and psychological effects. Women see yoga as a holistic practice that can meet their needs during pregnancy, birth and the postpartum period. Despite the physiological effects of breathing exercises and yoga postures on the body during yoga practice, studies are often interested in the psychological effects of yoga. However, study results show that yoga performed during pregnancy can reduce pregnancy-related physiological disorders, shorten childbirth times, reduce childbirth pain, and increase childbirth self-efficacy and vaginal birth rate. Yoga provides somatic body awareness, especially with the meditation and breathing exercises it includes. Awareness of the body's physiological and psychological changes increases women's self-efficacy during childbirth. Considering this aspect, there are gaps in the literature regarding the effect of yoga during pregnancy on women's self

Inclusion Criteria:

• Being primiparous
• Being between the ages of 18 -35
• Having a single and healthy fetus
• 24-32. being in the pregnancy week
• Being no psychiatric diagnosis or treatment
• Using an online meeting program (Zoom®)

Exclusion Criteria:

• Women doing body-mind-based exercises (yoga, meditation, progressive muscle relaxation, mindfulness, etc.).
• Women taking birth preparation training
• Women having a regular exercise habit of approximately 90-150 minutes per week
• Women with a high-risk pregnancy diagnosis
• Having become pregnant through assisted reproductive techniques
• According to the Wijma delivery expectancy questionnaire-A scale score, women with severe fear of childbirth will be excluded and referred to psychiatry.