Zeitschrift Fur Gesundheitswissenschaften · 6 authors, 6 centres
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This semi-experimental study of 96 pregnant women in Mashhad found that both face-to-face and virtual prenatal education significantly reduced fear of natural childbirth compared to routine care. The face-to-face group showed the greatest reduction in fear scores (mean change -47.43 vs -37.03 in the virtual group and -2.78 in controls, p<0.001). These findings support offering both in-person and virtual childbirth preparation classes to increase women's desire for natural childbirth.
**Background:** Fear of childbirth is a common psychological issue during pregnancy that can lead to increased rates of cesarean section. Prenatal education may reduce this fear, but traditional face-to-face classes face barriers including time constraints, distance, and urban traffic. Virtual education offers a potential alternative. This study compared the effectiveness of face-to-face versus virtual prenatal education on fear of natural childbirth in pregnant women.
**Methods:** This semi-experimental study with a control group was conducted in Mashhad, Iran, between 2018-2019. A total of 96 pregnant women at 20-24 weeks gestation were recruited using available sampling and randomly allocated to three groups (32 each): face-to-face education, virtual education, and control. Inclusion criteria included age 18-40 years, singleton pregnancy, ability to read and write Persian, no contraindications for natural childbirth, and access to a smartphone with internet. The face-to-face group attended four weekly 45-minute group discussion sessions covering common pregnancy problems, mental health and fear of childbirth, stages of natural childbirth and pain reduction, and child care. The virtual group received identical educational content (videocasts, PDFs, and video files) uploaded to a messenger channel over 4 weeks. The control group received routine care only. Fear of childbirth was measured using the Wijma Delivery Expectation/Experience Questionnaire version A (W-DEQ-A) at baseline and 3 months after intervention. Scores ≤37 indicate mild fear, 38-65 moderate fear, 66-84 severe fear, and ≥85 clinical fear.
**Key Results:** The mean age of participants was 30.56±5.3 years. At baseline, 16.7% had mild fear, 34.4% had moderate fear, and 49% had severe fear of natural childbirth. After the intervention, 66.7% had mild fear, 20.8% had moderate fear, and 15.5% had severe fear. The mean fear scores before intervention were: face-to-face group 71.4±29.66, virtual group 69.81±20.49, control group 54.34±23.7 (p=0.013). Three months after intervention, mean scores were: face-to-face 23.96±15.01, virtual 32.78±11.69, control 51.56±28.89 (p<0.001). The mean changes in fear scores were: face-to-face -47.43±36.18, virtual -37.03±21.54, control -2.78±18.47 (p<0.001). Covariance analysis controlling for baseline fear and spouse's education showed both face-to-face (regression coefficient -34.33, SE 5.17, p<0.001) and virtual education (regression coefficient -33.28, SE 5.12, p<0.001) significantly reduced fear compared to control.
**Clinical Implications:** Both face-to-face and virtual prenatal education effectively reduce fear of natural childbirth, with face-to-face showing greater reduction. Virtual education offers a practical alternative for women unable to attend in-person classes due to time constraints, distance, or health concerns (e.g., during the COVID-19 pandemic). Group discussion methods appear particularly effective. These findings support expanding access to childbirth preparation classes through multiple delivery modalities to increase women's desire for natural childbirth and potentially reduce unnecessary cesarean sections.