This randomized controlled trial was conducted to evaluate the effect of Pecha Kucha-based normal birth education on birth beliefs and mode of birth preferences among primiparous pregnant women considering elective cesarean section without a medical indication. A total of 76 pregnant women between 28 and 32 weeks of gestation were randomly assigned to either an experimental group or a control group. The experimental group received normal birth education using the Pecha Kucha presentation technique, whereas the control group received the same educational content through a traditional face-to-face oral presentation. Birth beliefs and birth mode preferences were assessed before the intervention, immediately after the intervention, and one month after the intervention. The study aimed to determine whether a brief, structured, and visually supported educational intervention could improve beliefs regarding normal birth and increase preference for vaginal delivery among women considering elective cesarean section.

Background Cesarean section rates have increased substantially worldwide and represent an important public health concern. In addition to medical indications, maternal preference has emerged as a contributing factor to elective cesarean section. Women's beliefs about childbirth are known to influence their delivery preferences. Belief in birth as a natural process is associated with viewing childbirth as a normal and safe physiological event, whereas belief in birth as a medical process is associated with perceiving childbirth as potentially dangerous and requiring medical intervention. Prenatal education provided by healthcare professionals may influence these beliefs and subsequently affect women's birth preferences.

Pecha Kucha is a structured presentation technique consisting of 20 slides displayed for 20 seconds each, resulting in a total presentation time of 6 minutes and 40 seconds. The method emphasizes concise communication through visual materials and has been reported to facilitate attention, comprehension, and retention of information. Although the Pecha Kucha technique has been used in various health education settings, evidence regarding its effectiveness in antenatal education is limited.

Objective The objective of this study was to determine the effect of Pecha Kucha-based normal birth education on birth beliefs and mode of birth preferences among pregnant women considering elective cesarean section.

Study Design This study was conducted as a single-blind, randomized controlled trial between March 2025 and June 2025 in Family Health Centers affiliated with a district Health Directorate in southern Türkiye. Participants were randomly assigned to either an experimental group or a control group using a simple randomization method. Women who met the eligibility criteria were allocated by drawing numbered papers from a box.

Participants The study included primiparous pregnant women who were at least 20 years of age, between 28 and 32 weeks of gestation, considering elective cesarean section without a medical indication, able to read and speak Turkish, and willing to participate. Women with maternal or fetal conditions requiring cesarean delivery and those who did not meet the inclusion criteria were excluded. A total of 76 participants completed the study, including 38 women in the experimental group and 38 women in the control group.

Interventions Both groups received education based on the Ministry of Health's Motherhood Journey Guide. Educational content included preparation for childbirth, birth planning, physiology and stages of labor, maternal and fetal changes during childbirth, coping with labor pain, breathing and relaxation techniques, movement and positioning during labor, benefits of vaginal birth, indications and risks of cesarean section, management of childbirth-related fears and anxieties, partner and family support, skin-to-skin contact, breastfeeding initiation, postpartum care, and common misconceptions regarding childbirth.

Participants in the experimental group received the educational content through the Pecha Kucha presentation technique. The presentation consisted of 20 visually supported slides presented for 20 seconds each. Participants in the control group received the same content through a conventional face-to-face oral presentation. Following the educational sessions, participants were given the opportunity to ask questions and receive feedback.

Outcome Assessment Data were collected at three time points: before the intervention (baseline), immediately after the intervention, and one month after the intervention. Outcome measures included the Birth Beliefs Scale and the Pregnant Women's Birth Mode Preferences Scale. The Birth Beliefs Scale evaluated beliefs regarding childbirth as a natural process and as a medical process. The Pregnant Women's Birth Mode Preferences Scale assessed preferences regarding vaginal birth and cesarean delivery.

Study Hypothesis The investigators hypothesized that normal birth education delivered through the Pecha Kucha technique would increase belief in childbirth as a natural process, decrease belief in childbirth as a medical process, and strengthen preferences for vaginal birth among pregnant women considering elective cesarean section.

Inclusion Criteria:

Female pregnant women aged 20 years or older. Primiparous. Between 28 and 32 weeks of gestation. Considering elective cesarean section. No maternal or fetal medical indication requiring cesarean delivery. Able to read, write, and speak Turkish. Willing to participate in the study and provide informed consent. Available to complete all study assessments throughout the study period.

Exclusion Criteria:

Younger than 20 years of age. Multiparous women. Presence of a maternal or fetal medical indication requiring cesarean delivery. Hearing or visual impairment that could interfere with participation in the educational intervention.

Inability to read, write, or speak Turkish. Refusal to participate or withdrawal of consent during the study. Failure to complete study procedures or follow-up assessments.