The effectiveness of group cognitive behavioral training in changing nulliparous women's attitudes and choice of delivery route

Considerable increase in the rate of cesarean section is currently a major health challenge in our country, Iran. Cesareans are performed mostly without having a medical indication and due to pregnant women’s negative attitude to normal vaginal delivery. This study was conducted to measure the effectiveness of group cognitive behavioral training in changing nulliparous women’s attitudes and choiceof delivery route.

Forty nulliparous women referring to Imam Khomeini Hospital, Mahallat, Iran, were recruited conveniently to this quasi-experimental study. The women were assigned to either the control or the experimental groups—20 women in each group. In the control group, the women solely received routine prenatal care while the women in the experimental group, received group cognitive behavioral training in addition to routine prenatal care. The data collection tool was the Attitude to Delivery Questionnaire. The SPSS software (v. 18.0) as well as the paired- and the independent-samples t, the McNemar’s, the Chi-square, and ANCOVA tests were used for data analysis. The level of significance was set at below 0.01.

Results show that in the experimental group, the mean of ADQ score significantly increased after the study (P=0.001), while in the control group, it did not change significantly. Moreover, the results of ANCOVA also revealed a significant difference between the study groups regarding the mean score of attitude (P=0.001). The results of the McNemar test were also significant. In other words, the number of women in the control and the experimental groups who chose normal vaginal delivery after the study intervention was equal to one and eight respectively (P=0.008).

Group cognitive behavioral training positively affects nulliparous women’s attitudes and their choice of normal vaginal delivery.