Guided Imagery and Positive Birth Experience Sharing on Fear of Childbirth and Self-Efficacy

The Effect of Guided Imagery and Positive Birth Experience Sharing on Fear of Childbirth and Self-Efficacy: A Randomized Controlled Trial

Abstract This study will be conducted to determine the effect of sharing positive birth experiences and mental imagery on birth self-efficacy and fear of childbirth. The study is a single-center, parallel-group, stratified block (in terms of fear of childbirth level) randomized controlled experimental study. The study sample will consist of a total of 84 participants, with 42 in the intervention group and 42 in the control group. The study is planned to be conducted between July 1, 2025, and July 1, 2026. Inclusion criteria for the study are: WİJMA A scale score average below 85, age over 18, being primiparous, being in the 20th to 26th week of pregnancy, having no complications in the mother or fetus during pregnancy (gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, congenital anomalies, etc.), having no communication problems (mental, auditory, visual, language, etc.), and volunteering to participate in the study. The study data will be collected using a personal information form, the Wijma Childbirth Expectancy/Experience Scale Version A (W-DEQ A), and the Childbirth Self-Efficacy Scale-Short Form (CBSEI-C32). Women will be invited to participate in online training sessions in groups of 3-10 people. Positive birth stories will be shared with the women, and visualization exercises will be demonstrated. Following the training sessions, the follow-up phase of the study will begin, and women will be provided with an audio recording of the visualization guidelines in MP3 format. Women will be asked to perform visualization exercises at least once or twice daily for a minimum of eight weeks. No intervention will be applied to the control group.

Problem Definition Cesarean delivery has significant benefits in high-risk pregnancies, but unnecessary and excessive use of cesarean section has negative consequences on the physical, emotional, and mental health of both mothers and babies. It also places an increasing financial burden on the healthcare system . The increase in the rate of planned cesarean sections before birth cannot be explained by clinical risk factors. This situation can be explained by mothers' preference for planned cesarean sections.

Women's preferences for cesarean sections before birth are influenced by social and cultural factors as well as psychological factors. The most commonly reported psychological factors associated with birth preferences are birth self-efficacy and fear of childbirth. Birth self-efficacy is defined as a person's belief that they can cope with the act of childbirth and the vaginal birth process. Carlson et al. reported that nulliparous women with low self-efficacy in the third trimester of pregnancy experienced higher levels of fear of childbirth compared to women with high self-efficacy. In another study, Lowe found that nulliparous women with lower childbirth self-efficacy were more likely to plan for a cesarean delivery compared to those with higher childbirth self-efficacy. In a study by Schwartz and colleagues, it was determined that self-efficacy is significantly associated with birth preference, independent of parity, and that the intention to have a cesarean delivery increases as self-efficacy decreases. Reducing fear of vaginal birth, thereby increasing positive perceptions of vaginal birth, is important in reducing cesarean preferences.

Having a positive birth experience with vaginal birth or hearing about someone else's positive birth experience can be effective. The sharing of birth stories has increased with the development of new technologies, and women can more easily access others' birth stories through multimedia platforms. Carlsson et al. reported that 97% of nulliparous women had heard birth stories from their mothers and friends. Amyx et al. noted that birth stories are the third most important source of information for nulliparous women, after healthcare professionals and prenatal classes. In a qualitative study of nulliparous women, birth stories were identified as the most useful source of information by 71% of women. Regardless of the type of birth, birth stories have a strong effect on self-efficacy and fear. Therefore, listening to positive birth stories may reduce birth fear in pregnant women.

In recent years, relaxation techniques aimed at reducing fear of childbirth have been increasingly used. One such relaxation technique, mental imagery, is a method for treating stress and anxiety by replacing distressing memories with positive mental images. This involves instructional guidance that triggers sensory experiences, behavioral, and physiological responses. Boryri et al. (2019) found that visualization was effective in reducing fear of childbirth in pregnant women to prevent planned and unnecessary cesarean sections. This study will be conducted to determine the effect of positive birth experience sharing and visualization on birth self-efficacy and fear of childbirth.

Inclusion Criteria:

• The WIJMA A scale score average should be below 85, be over 18 years of age, be primiparous, be in the 20-26th week of pregnancy, not have any complications in the mother or fetus during pregnancy (gestational diabetes, hypertension, preeclampsia, intrauterine growth retardation, congenital anomaly, etc.), not have any communication problems (mental, auditory, visual, language, etc.), and be willing to participate in the study.

Exclusion Criteria:

• Failure to perform post-tests,
• Participant's wish to withdraw from the study at any stage of the study,
• Pregnancy turning into a risky pregnancy,
• Birth occurring before the 37th week of pregnancy,
• Not performing the visualization exercise for at least three consecutive days.