Assessing Natural Childbirth Intention Based on the Theory of Planned Behavior and Social Support in Pregnant Women in Northern Iran

Childbirth is the most challenging physiological and psychological event in a woman’s life. Despite the recommendations of the Iranian Ministry of Health on having natural childbirth, no favorable statistics have been reported yet.

This study aims to determine the predictors of natural childbirth intention based on the extended theory of planned behavior (TPB) and social support in pregnant women referred to selected hospitals in Rasht, northern Iran.

This analytic cross-sectional study was conducted on 353 pregnant women aged 15-45 years referred to four hospitals in Rasht city in 2020 who were selected by systematic random sampling method proportional to the size of the study population. A researcher-made self-report questionnaire measuring the demographic information, the TPB constructs, social support, and natural childbirth intention was used. Data was analyzed using t-test, one-way ANOVA, Pearson correlation test, and multiple regression analysis. 

Most of the pregnant women had a high school diploma (43.6%) and were housekeepers (83.3%), living in the city (80.5%). Most of them were in the third trimester of pregnancy (37.7%) and had pregnancy for the first time (44.8%). Their mean age was 28.90±5.8, and 58.8% intended to give birth naturally. The mean score of the natural childbirth intention was 6.71±2.50. This intention had a direct correlation with all TPB constructs and social support (r=0.526-0.829; P=0.001). Based on results social support, and participation in childbirth education classes predicted 72% of changes in natural childbirth intention (R2 =0.72). Attitude alone was able to predict natural childbirth intention by 69% (β=0.12, 95% CI; 0.09%, 0.15%, P=0.001)

The power of the TPB constructs for predicting the natural childbirth intention in pregnant women in northern Iran is high. The attitude construct is the best predictor of natural childbirth intention. To increase the tendency to choose natural childbirth, educational interventions based on the TPB with an emphasis on attitudes can be useful. In addition, measures should be taken for the active participation of pregnant women in childbirth preparation classes.