Summary
Objectives:
Fear of childbirth is commonly reported among primigravida women and may negatively influence labour and birth outcomes. This study aimed to evaluate the effectiveness of a structured prenatal educational programme in reducing fear of childbirth among primigravida women.
Methods:
A quasi-experimental single-group pretest-post-test design was conducted from January to June 2025. The study included primigravida women attending antenatal clinics in selected health centres in Muscat Governorate, Oman. No control group was included. Participants completed the baseline assessment during the third trimester (28–40 weeks of gestation) prior to the intervention. Post-intervention assessment was conducted at two weeks postpartum using the Self-Evaluation Questionnaire.
Results:
A total of 79 primigravida women were included. Following the intervention, the mean fear-of-childbirth score decreased from 4.35 ± 0.63 at baseline to 1.79 ± 0.74 at 2-week postpartum follow-up, representing a mean reduction of 2.56 points (95% CI: 2.38–2.74; t = 27.8; P <0.001; Cohen's d = 3.12), indicating a statistically significant improvement after participation in the prenatal educational programme.
Conclusion:
The structured prenatal educational programme was associated with a reduction of fear of childbirth among primigravida women. Incorporating such programmes into routine antenatal care may enhance maternal psychological well-being in Oman and in similar maternal health settings.
Keywords: Prenatal Care, Health Education, Fear, Obstetric Labor, Pregnant Women, Oman
Advances in Knowledge
This study found that a scheduled prenatal education programme was associated with reduced childbirth fear in Omani primigravida women.
This study provides evidence on fear of childbirth and antenatal education outcomes among Omani women in primary care settings helping to inform policy and practice in Oman.
Application to Patient Care
These findings can guide Omani policymakers to embed prenatal education in routine primary-care antenatal services.
Routine structured prenatal education may improve childbirth experience and lessen fear of childbirth in primigravida women.
1. Introduction
Pregnancy and childbirth are natural physiological processes and major physical, emotional and social milestones in a woman's life.1 Fear of childbirth is nevertheless common and may adversely affect maternal well-being and birth outcomes, including prolonged labour, heightened pain perception and an increased likelihood of elective or instrumental delivery.2,3 Fear may also persist into the postpartum period and has been associated with delayed recovery, postpartum depression and higher levels of post-traumatic stress symptoms following childbirth.2,4
Structured antenatal education is an important strategy to support a positive pregnancy and childbirth experience. Evidence from systematic reviews and clinical studies suggests that such programmes may reduce fear of childbirth and improve maternal self-efficacy, with potential benefits for birth outcomes, including mode of delivery.5 A recent systematic review and meta-analysis has shown that antenatal education significantly reduces fear of childbirth and improves childbirth-related psychological outcomes.6 In addition, antenatal education programmes have demonstrated improvements in maternal confidence and childbirth self-efficacy in primiparous women.7,8 Furthermore, prenatal education has been shown to enhance maternal understanding of pregnancy and childbirth-related topics and support better preparedness for delivery through structured educational interventions.1,5 However, evidence on the effect of antenatal education on fear of childbirth remains inconsistent. A Cochrane systematic review reported mixed findings, with considerable variability in intervention content, timing and outcome measures across studies, limiting the certainty of conclusions.9 This highlights the need for further evaluation of structured prenatal education programmes in different healthcare contexts.
In Oman, structured antenatal education is largely confined to two tertiary referral institutions in Muscat. Most women, however, receive routine antenatal care in primary healthcare centres, where structured education is not typically provided. As a result, many women may have limited access to organised preparation for childbirth and the postpartum period, particularly in relation to labour and birth, postpartum care and newborn care.10 Furthermore, there is limited local evidence regarding the effectiveness of structured antenatal education in addressing fear of childbirth among Omani primigravida women. Generating such evidence is important to inform clinical practice and strengthen woman-centred antenatal care within primary healthcare settings. Therefore, this study aimed to evaluate the effectiveness of a structured prenatal educational programme in reducing fear of childbirth among primigravida women. The null hypothesis was that there would be no difference in fear-of-childbirth scores before and after participation in the programme, whereas the alternative hypothesis was that participation in the programme would result in a reduction in fear-of-childbirth scores.
2. Methods
This study employed a single-group pre-test–post-test design to compare fear-of-childbirth scores before and after a structured prenatal educational programme among primigravida women. A quasi-experimental pre-post design was considered appropriate given the need to evaluate this intervention in a real-world primary healthcare setting, where randomisation and control conditions are often not feasible. The study was structured using the PICO framework. The population (P) comprised primigravida women attending four antenatal clinics at selected primary healthcare centres in Muscat Governorate, Oman, from January–June 2025. The intervention (I) was a structured prenatal educational programme. There was no comparison group (C), as the study used a quasi-experimental pre–post design. The outcome (O) was fear of childbirth among primigravida women. This design is commonly applied in health professions education and clinical intervention research to assess change following educational programmes in real-world settings where randomisation is not feasible or may disrupt routine care delivery.11
A purposive sampling approach was used to recruit primigravida women with singleton pregnancies. Participants were included if they were willing to take part in the structured prenatal educational programme and able to complete the study procedures and assessments. Four participants were recruited before the third trimester to facilitate recruitment and ensure achievement of the required sample size. However, all baseline assessments of fear of childbirth and the intervention were conducted when participants reached the third trimester (28–40 weeks’ gestation). Women with medical or obstetric complications were excluded. Purposive sampling was used to ensure recruitment of participants who met the eligibility criteria and were expected to benefit from the intervention.
Sample size was calculated using PASS, Version 24.0.2 (NCSS Statistical Software, Kaysville, Utah, USA) for a paired t-test, assuming a moderate effect size (Cohen's d ≈ 0.5) as supported by evidence of moderate effects of antenatal education reported in the literature.12 With a 5% significance level, 80% power and a 20% attrition rate, the minimum required sample was 60 participants.
The intervention comprised a structured prenatal educational programme delivered by trained healthcare professionals through group workshops and individual counselling. The programme included two sessions, each lasting approximately 60–90 minutes. Content covered stages of labour, pain management strategies, relaxation and breathing techniques, psychological preparation for childbirth and postpartum care. Sessions were delivered face-to-face and supported by videos, visual aids and anatomical models. Educational materials were developed using validated medical resources.
Fear of childbirth was assessed at baseline (third trimester) and at 2-week postpartum follow-up using the Structured Evaluation Questionnaire (SEQ). The SEQ is a researcher-developed instrument consisting of four sections: socio-demographic characteristics (age, educational level, employment status, marital status and gestational age); fear-of-childbirth items rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree); prior exposure to prenatal educational programmes; and perceived effectiveness of the current intervention in reducing fear of childbirth [Supplementary Appendix 1 – Study Questionnaire].
Fear-of-childbirth items covered emotional, cognitive and behavioural responses to childbirth. Content validity was established through expert review by three experts in maternal health and midwifery, and the tool was pilot tested for clarity and feasibility among primigravida women. Internal consistency was acceptable (Cronbach's α = 0.82 at baseline and 0.85 at follow-up).
Eligible participants were escorted to a private room within the health centre to ensure privacy and confidentiality. Participants completed the pre-intervention questionnaire prior to the educational sessions. Follow-up assessment was conducted 2 weeks postpartum using the same fear-of-childbirth items to capture early postpartum levels of childbirth-related fear. A follow-up period of 2 weeks postpartum was selected to minimise loss to follow-up while keeping the recall period short. The investigator was available to clarify questionnaire items as required.
Potential sources of bias included self-reported responses and variability in participants’ engagement with the educational sessions. These were addressed by standardising the educational content, ensuring consistent delivery by trained professionals and allowing time for questions and clarification. Data were stored securely in password-protected software accessible only to the research team.
Data were coded and checked for completeness and consistency prior to analysis; no missing data were identified. Categorical variables were summarised as frequencies and percentages, and continuous variables as means and standard deviations. Normality of the within-participant difference scores was assessed using the Shapiro-Wilk test to confirm suitability for paired t-test analysis. Paired t-tests were used to compare pre- and post-intervention fear-of-childbirth scores. Mean differences were reported with 95% confidence intervals (CIs). Effect size was calculated using Cohen's d for paired samples to quantify the magnitude of change and interpreted as small (0.2), medium (0.5) and large (0.8). A P value <0.05 was considered statistically significant. Analyses were conducted using Python, Version 3.10 (Python Software Foundation, Wilmington, Delaware, USA), with the Pandas and SciPy packages. Exploratory subgroup analyses were conducted to examine whether changes in fear-of-childbirth scores differed by maternal age, educational level and employment status using independent t-tests or one-way ANOVA as appropriate. Because follow-up occurred postpartum, the pre-post comparison reflected change from late pregnancy to early postpartum and may be influenced by the childbirth experience.
3. Results
A total of 79 primigravida women were included. Most were aged 26–35 years (57.0%). Nearly half held a bachelor's degree (48.1%) and over half (54.4%) were employed. Gestational age at recruitment was 28–40 weeks (third trimester) for 94.9% of the sample [Table 1].
Table 1.
Characteristics of the included primigravida women (N = 79).
| Characteristic | n (%) |
|---|---|
| Age in years | |
| 18–25 | 10 (12.7) |
| 26–35 | 45 (57.0) |
| >35 | 24 (30.4) |
| Education level | |
| Bachelor's degree | 38 (48.1) |
| Diploma | 27 (34.2) |
| High school | 14 (17.7) |
| Employment status | |
| Employed | 43 (54.4) |
| Unemployed | 35 (44.3) |
| Student | 1 (1.3) |
| Gestational age at recruitment (weeks) | |
| 1–12 | 1 (1.3) |
| 13–27 | 3 (3.8) |
| 28–40 | 75 (94.9) |
At baseline, fear-of-childbirth scores was generally high, with most women selecting high or very high scores (4–5) across the assessed domains (pain, complications, lack of support during labour, prolonged labour, episiotomy and caesarean section). Fear of episiotomy was the most prominent concern, with 63.3% of respondents selecting the maximum score of 5 [Table 2].
Table 2.
Baseline item-level fear scores across childbirth-related domains among primigravida women (N = 79).
| Fear score, n (%) | |||||
|---|---|---|---|---|---|
|
|
|||||
| Fear domain | 1 | 2 | 3 | 4 | 5 |
| Fear of pain | 1 (1.3) | 0 (0.0) | 8 (10.1) | 27 (34.2) | 43 (54.4) |
| Fear of complications | 1 (1.3) | 1 (1.3) | 4 (5.1) | 28 (35.4) | 45 (57.0) |
| Fear of lack of support during labour | 1 (1.3) | 1 (1.3) | 7 (8.9) | 50 (63.3) | 20 (25.3) |
| Fear of lengthy labour | 0 (0.0) | 3 (3.8) | 12 (15.2) | 26 (32.9) | 38 (48.1) |
| Fear of episiotomy | 2 (2.5) | 1 (1.3) | 8 (10.1) | 18 (22.8) | 50 (63.3) |
| Fear of caesarean section | 3 (3.8) | 0 (0.0) | 1 (1.3) | 26 (32.9) | 49 (62.0) |
Prior attendance at prenatal educational programmes was limited; 21 women (26.6%) reported previous attendance, while 58 (73.4%) reported none. Among those who had attended, healthcare providers were the most frequently reported information source (48.1%) [Table 3].
Table 3.
Previous attendance and sources of information on prenatal educational programmes prior to the study intervention (N = 79).
| Variable | n (%) | |
|---|---|---|
| Previous attendance at prenatal educational programme | ||
| Yes | 21 (26.6) | |
| No | 58 (73.4) | |
| Source of information | ||
| Healthcare providers | 38 (48.1) | |
| Internet | 24 (30.4) | |
| Family and friends | 17 (21.5) | |
Most women reported a perceived benefit from the programme (97.5%). A total of 46 participants (58.2%) indicated that the programme reduced fear of childbirth ‘to a large extent’. With respect to preparedness for childbirth, 32.9% reported feeling ‘very prepared’. Few reported being ‘slightly prepared’ (7.6%) or ‘not prepared’ (1.3%) [Table 4].
Table 4.
Perceived benefits and childbirth preparedness following the educational programme (N = 79).
| Variable | n (%) |
|---|---|
| Benefited from the programme | |
| Yes | 77 (97.5) |
| To some extent | 2 (2.5) |
| Programme reduced fear of childbirth | |
| Yes, a lot | 46 (58.2) |
| Yes, somewhat | 33 (41.8) |
| Preparedness for childbirth | |
| Very prepared | 26 (32.9) |
| Moderately prepared | 46 (58.2) |
| Slightly prepared | 6 (7.6) |
| Not prepared | 1 (1.3) |
Participants proposed several topics for inclusion in future programmes. The most frequently recommended topic was stages of labour (35.4%), whereas emotional and psychological aspects (12.7%) and postpartum care (11.4%) were recommended less often. With respect to programme components, ‘discussion with specialists’ was most often rated as the single most useful element (38.0%), whereas ‘emotional preparation’ was selected least often (2.5%) [Table 5].
Table 5.
Recommended topics and most beneficial components of the educational programme (N = 79).
| Category | n (%) |
|---|---|
| Recommended topics | |
| Stages of labour | 28 (35.4) |
| Relaxation and breathing | 17 (21.5) |
| Pain management | 15 (19.0) |
| Emotional and psychological aspects | 10 (12.7) |
| Postpartum care | 9 (11.4) |
| Most beneficial components | |
| Discussion with specialists | 30 (38.0) |
| Exercise sessions | 22 (27.8) |
| Pain management | 16 (20.3) |
| Support from others’ experiences | 5 (6.3) |
| Stages of labour | 4 (5.1) |
| Emotional preparation | 2 (2.5) |
The mean fear-of-childbirth score decreased from 4.35 ± 0.63 at baseline to 1.79 ± 0.74 at 2-week postpartum follow-up, representing a mean reduction of 2.56 points. This reduction was statistically significant (t = 27.8; P <0.001). The mean difference was 2.56 (95% CI: 2.38–2.74). The effect size was very large (Cohen's d = 3.12) indicating a strong intervention effect.
At post-intervention evaluation, 76 participants (96.2%) reported a reduction in fear of childbirth, while 2 (2.5%) reported no change and 1 (1.3%) reported increased fear. Most participants strongly agreed that they felt more confident at the time of birth (62.1%), while 43.0% strongly agreed and 54.5% agreed that they were prepared emotionally and psychologically. Furthermore, 78.5% strongly agreed and 19.0% agreed that they would recommend the programme [Table 6].
Table 6.
Post-intervention evaluation of the prenatal educational programme (N = 79).
| Variable | Response category | n (%) |
|---|---|---|
| Change in fear of childbirth | Reduced | 76 (96.2) |
| No change | 2 (2.5) | |
| Increased | 1 (1.3) | |
| Feeling more confident at time of birth | Strongly agree | 49 (62.1) |
| Agree | 28 (35.4) | |
| Neutral | 2 (2.5) | |
| Prepared emotionally and psychologically | Strongly agree | 34 (43.0) |
| Agree | 43 (54.5) | |
| Neutral | 2 (2.5) | |
| Recommendation of programme | Strongly agree | 62 (78.5) |
| Agree | 15 (19.0) | |
| Neutral | 2 (2.5) |
A subgroup analysis was conducted to examine whether fear-of-childbirth scores differed according to maternal age and educational level. A one-way ANOVA demonstrated a statistically significant difference in mean fear of childbirth scores across maternal age groups (F = 3.31; P = 0.042). Women aged 28–40 years had a mean fear score of 26.36 ± 3.46, compared with 21.00 ± 6.24 among women aged 13–27 years and 25.00 in the single participant within the remaining age category. These findings suggest that fear of childbirth varied according to maternal age. However, no statistically significant differences were observed in fear-of-childbirth scores across educational levels (F = 1.94; P = 0.151). Mean fear scores ranged from 25.36 ± 3.15 to 26.97 ± 3.42 across the three education categories, indicating that educational attainment was not significantly associated with fear of childbirth in this sample.
4. Discussion
This study evaluated the effectiveness of a structured prenatal educational programme in reducing fear of childbirth among primigravida women. In this study, many women had (48.1%) a bachelor's degree and 57.0% were aged 26–35 years. These characteristics may reflect the high educational profile of women attending primary care in Muscat and, possibly, a later age at first pregnancy in this setting.
High baseline levels of fear of childbirth were observed across several domains, including pain, complications, perceived lack of support during labour, prolonged labour, episiotomy and caesarean section. Fear of episiotomy emerged as the most prominent concern, which is consistent with the international literature identifying episiotomy as a key contributor to childbirth-related fear.13,14 These findings underline the need for targeted counselling and structured antenatal education addressing specific fears, including episiotomy. Elevated fear during pregnancy has been associated with adverse maternal and neonatal outcomes, including operative delivery, postpartum haemorrhage, severe preeclampsia and neonatal complications such as birth asphyxia.15
The majority of the participants (73.4%) reported no prior attendance at a structured prenatal educational programme, while some (26.6%) reported previous attendance. This pattern of limited baseline utilisation aligns with a randomised controlled trial conducted by Francis et al., who reported that only 6.67% of total participants fully completed all ten recommended sessions in the group care model.16 This low completion rate was driven primarily by inflexible timings or childcare constraints (23.19%), personal preferences for private care (16.43%) and a lack of strong family support systems.16 This widespread limited uptake supports the need for structured, accessible antenatal programmes delivered through primary healthcare services. Among those who had previously attended a prenatal educational programme in the current study, healthcare providers were the most frequently cited source of information (48.1%), followed by the internet (30.4%). This underscores that healthcare providers are vital to informing women about prenatal education and actively encouraging them to attend these sorts of programmes.
Nearly all participants (97.5%) perceived benefit from the programme, particularly in relation to a reduction in fear of childbirth and improved preparedness for labour. This is supported by a prospective randomised trial by Kaya et al. which reported that a structured 6-week programme reduced fear of childbirth, with greater reduction in Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) scores in the intervention group (P <0.0001), alongside documented decreases in maternal stress and enhancements in postpartum mental well-being.17 However, the study included only women with severe baseline fear and employed an intensive multidisciplinary programme, which may have contributed to the magnitude of the observed effect and may limit the generalisability of the findings to routine primary healthcare settings.
Structured prenatal education has also been associated with improved maternal knowledge, informed decision-making and better preparation for labour and postpartum care. The World Health Organization's Compendium on Respectful Maternal and Newborn Care highlights the importance of woman-centred care that ensures effective communication, information provision and psychosocial support throughout maternity services, thereby promoting informed and respectful childbirth experiences.18 From a policy perspective, these findings may support piloting structured antenatal education programmes in primary healthcare settings.
Interestingly, in the current study, participants recommended additional topics for future antenatal education programmes, such as stages of labour, emotional and psychological aspects of childbirth and postpartum care. These findings suggest that women have broader educational needs beyond reducing fear of childbirth; this highlights the importance of comprehensive antenatal education within primary healthcare settings. Healthcare providers need to consider the importance of expanding the content of the antenatal educational programme which may play a key role in fulfilling women's needs, increase their satisfaction and improve the overall childbirth experience.
Prenatal education was associated with a statistically significant reduction in fear-of-childbirth scores (t = 27.8; P <0.001). The findings are broadly consistent with a systematic review, in which 40 studies involving 1,116 pregnant women reported improvements in childbirth self-efficacy and reductions in fear of childbirth following antenatal education, although effect sizes varied considerably (self-efficacy: standardised mean difference [SMD] = 2.00, 95% CI: 1.06–2.95; fear of childbirth: SMD = -1.26, 95% CI: -1.79 to -0.74).12 On the other hand, there are some studies reported mixed or inconclusive findings, which may be small sample sizes, heterogeneous interventions and risk of bias.6,19 These inconsistencies underscore the need for well-designed, context-specific evaluations of structured prenatal educational programmes, particularly in settings where local evidence remains limited.
Subgroup analysis revealed a significant association between maternal age and fear of childbirth, whereas educational level was not significantly associated with fear scores. This result is consistent with recent evidence indicating that maternal age may be associated with variations in fear of childbirth, with younger women in particular often reporting higher levels of anxiety and fear related to labour and delivery.20,21 In regards to the educational level, several recent studies have reported no significant association between educational level and fear of childbirth which supports the finding of the current study.22 However, findings are inconsistent across populations, with some studies reporting that younger women and those with lower educational attainment experience higher levels of fear of childbirth, while other studies show no statistically significant associations after adjustment for confounding factors.2,4,6 Overall, these findings suggest that the relationship between sociodemographic factors and fear of childbirth may be context-specific rather than acting as isolated predictors.
This study has several important strengths. It provides locally relevant evidence on the effectiveness of a structured prenatal educational programme in reducing fear of childbirth among primigravida women in Oman, thereby contributing to the limited body of knowledge on this topic within the local context. The study also identified specific areas of childbirth-related fear among primigravida women, with fear of episiotomy emerging as the most prominent concern. These findings provide valuable insights for healthcare providers and may assist in developing targeted educational interventions that address women's specific fears and informational needs, thereby supporting holistic, woman-centred care. In addition, the findings provide evidence that structured prenatal education may improve psychological preparedness for childbirth and reduce childbirth-related fear. Such evidence may inform the development of future policies, guidelines and standards related to antenatal education and maternal health services. The results may also support efforts to strengthen routine antenatal care, enhance women's childbirth experiences and improve the quality of maternity care.
The study has some limitations that should be acknowledged. The absence of a comparison group in the single-group pre-test-post-test design means that the observed change in fear scores cannot be attributed to the intervention with certainty, as other factors over time may have contributed. This design was selected to provide a preliminary evaluation of the programme in a real-world primary healthcare setting and to assess its potential effectiveness before undertaking more rigorous controlled studies. In addition, fear of childbirth was measured using self-reporting, which may be influenced by response tendencies such as social desirability bias or recall bias following childbirth. To minimise this risk, participants completed questionnaires in a private setting and were assured of confidentiality.
Although the single-group pre–post design limits causal inference, this study provides locally relevant evidence and may inform the development and evaluation of structured antenatal education programmes within primary healthcare settings in Oman.
5. Conclusion
This study suggested that a structured prenatal educational programme may contribute to reducing fear of childbirth among primigravida women in a primary healthcare setting. The findings highlighted the potential value of integrating structured antenatal education into routine maternity care, particularly within primary healthcare services where such programmes are limited. Further research using controlled study designs, larger samples and multi-site implementation is recommended to confirm effectiveness and assess the long-term impact of antenatal education on fear of childbirth.
Authors’ Contribution
Mozah Nasser Al Mamari: Conceptualization, Methodology, Formal analysis, Visualization, Writing - original draft and Review and Editing. Amal Al Hadi: Conceptualization, Methodology, Project administration, visualization, Supervision and writing - original draft, review and editing. Fahima Al Harthy: Conceptualization, Visualization, Supervision, Writing - original draft. Shamsa Al Ghusaini: Conceptualization, Visualization, Writing - original draft and Review and editing. Kadhiya Al Riyami: Conceptualization, Methodology, Formal analysis, Visualization, Writing - original draft.
Acknowledgement
The authors would like to acknowledge Ms. Thuraya Al-Kharusi, Ms. Zeena Al-Mahrooqi, Ms. Hanna Al-Naamani and Ms. Rhama Al-Shuhemi for their participation in the study. Additionally, the principal investigator and co-authors would like to thank the participants who volunteered to participate in this study.
Ethics Statement
Ethical approval was granted from Health Studies and Research Approval Committee (HSRAC) [MOH/CSR/24/29142], Ministry of Health, Oman. Written informed consent was obtained from all participants prior to data collection. Participant confidentiality and anonymity were maintained throughout the study and participants were informed that they could withdraw at any stage without impact on their care. Clinical trial registration was not pursued because this study was designed as a single-group quasi-experimental pre-test–post-test evaluation of a prenatal educational programme implemented within routine primary healthcare services.
Conflict of Interest
The authors declare no conflicts of interest.
Funding
This study did not receive any funding.
Data Availability
Data are available upon reasonable request from the corresponding author.
References
- [1].Abd El-Aziz SN, Mansour SE, Hassan NF. Factors associated with fear of childbirth: its effect on women's preference for elective cesarean section. J Nurs Educ Pract 2017; 7:133–45. 10.5430/jnep.v7n1p133. [DOI] [Google Scholar]
- [2].Dencker A, Nilsson C, Begley C, Jangsten E, Mollberg M, Patel H, et al. , Causes and outcomes in studies of fear of childbirth: a systematic review. Women Birth 2019; 32:99–111. https://doi.org/10.1016/j.wombi.2018.07.004. 10.1016/j.wombi.2018.07.004 [DOI] [PubMed] [Google Scholar]
- [3].Huang H, Zhou H, Zheng H, San S, Deng Y, Qiu D, et al. , Fear of childbirth among pregnant women in hospital for delivery and its impact on birth outcomes and lactation initiation: a prospective longitudinal study in Wuhan. BMC Pregnancy Childbirth 2025; 25:724. https://doi.org/10.1186/s12884-025-07569-1. 10.1186/s12884-025-07569-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Alizadeh-Dibazari Z, Abdolalipour S, Mirghafourvand M. The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using a systematic approach and meta-analysis. BMC Pregnancy Childbirth 2023; 23:541. https://doi.org/10.1186/s12884-023-05867-0. 10.1186/s12884-023-05867-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Fadelbenyian F, Mohsen Ali R. Effectiveness of an educational program on primigravida women's childbirth fear at Al Elwea Maternity Hospital in Baghdad City. Pak J Med Health Sci 2021; 15:790–3. [Google Scholar]
- [6].Karaçam Z, Ofei P, Uzunoğlu G, Günes Oztürk G. The effect of prenatal education on the fear of childbirth: a systematic review and meta-analysis. Arch Womens Ment Health 2026; 29:37. 10.1007/s00737-025-01635-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [7].Thomas AM, Solomon SG. A study to assess the effectiveness of midwife-led psychoeducation on childbirth fear and childbirth efficiency in primigravida mothers at a selected hospital in Navi Mumbai. Indian J Nurs Sci 2023; 8:64–70. https://doi.org/10.31690/ijns.2023.v08i03.013. 10.31690/ijns.2023.v08i03.013 [DOI] [Google Scholar]
- [8].Cankaya S, Simsek B. Effects of antenatal education on fear of birth, anxiety, self-efficacy, and mode of delivery in primiparous women. Clin Nurs Res 2021; 30:818–29. https://doi.org/10.1177/1054773820916984. 10.1177/1054773820916984 [DOI] [PubMed] [Google Scholar]
- [9].Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev 2013; 7:CD003766. 10.1002/14651858.CD003766.pub5. [DOI] [PubMed] [Google Scholar]
- [10].Mohamed AA, Bocher T, Magan MA, Omar A, Mutai O, Mohamoud SA, et al. , Experiences from the field: a qualitative study exploring barriers to maternal and child health service utilization in IDP settings Somalia. Int J Womens Health 2021; 13:1147–60. https://doi.org/10.2147/IJWH.S330069. 10.2147/IJWH.S330069 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [11].Shaliha F, Jafarzadeh-Kenarsari F, Bostani-Khalesi Z, Maroufizadeh S, Alimoradi Z. Effects of educational intervention based on childbirth scenarios on fear of childbirth in primiparous women. J Educ Health Promot 2024; 13:291. 10.4103/jehp.jehp_870_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [12].Zaman A, Fadlalmola HA, Ibrahem SE, Ismail FH, Abedelwahed HH, Ali AM, et al. , The role of antenatal education on maternal self-efficacy, fear of childbirth, and birth outcomes: a systematic review and meta-analysis. Eur J Midwifery 2025; 9:1–16. https://doi.org/10.18332/ejm/200747. 10.18332/ejm/200747 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [13].He S, Jiang H, Qian X, Garner P. Women's experience of episiotomy: a qualitative study from China. BMJ Open 2020; 10:e033354. https://doi.org/10.1136/bmjopen-2019-033354. 10.1136/bmjopen-2019-033354 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Hosaini S, Yazdkhasti M, Moafi Ghafari F, Mohamadi F, Kamran Rad SH, Mahmoodi Z. The relationships of spiritual health, pregnancy worries and stress and perceived social support with childbirth fear and experience: a path analysis. PLoS One 2023; 18:e0294910. https://doi.org/10.1371/journal.pone.0294910. 10.1371/journal.pone.0294910 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [15].Ali MH, Seif SA, Kibusi SM. The influence of fear during pregnancy, labour and delivery on birth outcome among post-delivery women: a case control study in Zanzibar. East Afr Health Res J 2022; 6:147–54. https://doi.org/10.24248/eahrj.v6i2.693. 10.24248/eahrj.v6i2.693 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Francis E, Johnstone MB, Covington-Kolb S, Witrick B, Griffin SF, Sun X, et al. , Group prenatal care attendance and women's characteristics associated with low attendance: results from Centering and Racial Disparities (CRADLE Study). Matern Child Health J 2019; 23:1371–81. https://doi.org/10.1007/s10995-019-02784-7. 10.1007/s10995-019-02784-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [17].Kaya L, Bilge Y, Keles E, Erkok U, Kaya Z. Effect of antenatal education on fear of childbirth, mental health, and perceived stress in primigravid pregnant women: a prospective randomized controlled trial. BMC Pregnancy Childbirth 2025; 25:1342. https://doi.org/10.1186/s12884-025-08544-6. 10.1186/s12884-025-08544-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].World Health Organization. Compendium on respectful maternal and newborn care. Geneva, Switzerland: World Health Organization, 2025. pp. 1–171. [Google Scholar]
- [19].Karabulut O, Coskuner Potur D, Doğan Merih Y, Cebeci Mutlu S, Demirci N. Does antenatal education reduce fear of childbirth? Int Nurs Rev 2016; 63:60–7. https://doi.org/10.1111/inr.12223. 10.1111/inr.12223 [DOI] [PubMed] [Google Scholar]
- [20].AlDardeir NF, Shafei JA, Abdulaziz HH, Edrees GW, Jifri RA, AlShehri SH, et al. , Reasons for childbirth-related fear among pregnant women: A cross-sectional study in a teaching institution. J Family Med Prim Care 2025; 14:2407–15. https://doi.org/10.4103/jfmpc.jfmpc_1828_24. 10.4103/jfmpc.jfmpc_1828_24 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Effati Daryani F, Mohammadi A, Mirghafourvand M. Childbirth self-efficacy and fear of childbirth and their predictors in adolescent and adult pregnant women referring to health centres of Urmia-Iran: a cross-sectional study. BMJ Open 2023; 13:e077043. https://doi.org/10.1136/bmjopen-2023-077043. 10.1136/bmjopen-2023-077043 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [22].Jing Q, Jie J, Ke X, Liu Y, Xiumin D, Xiuchuan L, et al. , The relationship between fear of childbirth and prenatal depression in pregnant women during pregnancy: a cross-lagged analysis. BMC Pregnancy Childbirth 2025; 25:192. https://doi.org/10.1186/s12884-025-07321-9. 10.1186/s12884-025-07321-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
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Data Availability Statement
Data are available upon reasonable request from the corresponding author.