Is Prenatal Self-Efficacy Enhancing Educational Programme Effective in Improving Maternal Self-Efficacy During Intrapartum Period?
Vasanthi RM1, Manju Bala Dash2* and Felicia Chitra A3
1Nursing (OBG), India
2Department of OBG, India
3 Principal cum Research Guide, India
Submission: September 11, 2019; Published: October 29, 2019
*Corresponding author: Manju Bala Dash, HOD, Department of OBG, MTPG&RIHS, Puducherry, India
How to cite this article:Vasanthi RM, Manju Bala Dash, Felicia Chitra A. Is Prenatal Self-Efficacy Enhancing Educational Programme Effective in
Improving Maternal Self-Efficacy During Intrapartum Period?. JOJ Pub Health. 2019; 5(3): 555661.
Background: Becoming mother is the awesome feel and greatest gift for the women in her aliveness. Over 90% of antenatal pressure and anxiety is associated to the development of childbearing. Mother’s anxiety in this duration frequently is due to the lack of information and antenatal fear of the unidentified risks and childbirth. Stimulation of antenatal knowledge and ability makes mothers for delivery and augment their health.
Aim: To evaluate the effectiveness of prenatal self-efficacy enhancing educational programme on maternal self-efficacy during intrapartum period.
Subjects and Methods: The Quantitative Quasi-experimental (post-test only control group) design was used among prenatal mothers in selected hospital at Puducherry. Sample size was 82, selected by purposive sampling technique. Data collection was done with the self- administered questionnaire. It has three sections. Section A: Demographic and obstetric variables, Section B: Modified Nancy Standardised Likert scale for estimation of self-efficacy during first and second stage and Section C: Self-Efficacy Expectancy Checklist on third and fourth stage of labour.
Results: The major findings of the study showed that in the experiment group, the majority 39 (95.1%) mothers had high level of self-efficacy in first stage of labour, 32 (78%) mothers had high level of self-efficacy in second stage of labour and 41 (100%) mothers had high level of self-efficacy in third and fourth stage of labour. Whereas in the control group, majority 29 (70.7%) mothers had moderate level of self-efficacy during first stage of labour, 33 (80.5%) mothers had low level of self-efficacy in second stage of labour and 35 (85.4%) mothers who had moderate level of self-efficacy during third and fourth stage of labour. So, the level of self-efficacy had enhanced with experimental group than control group mothers.
Conclusion: The study results highlighted and proved statistically (p<0.001) that Prenatal Self-Efficacy Enhancing Educational Program was found to be effective in reducing fear and enhance individual’s self-efficacy during intrapartum period through the difference in the level of self-efficacy among experiment and control group which ultimately reduces caesarean section and indirectly decreasing morbidity and mortality rate.
Keywords:Antenatal self-efficacy enhancing programme; Antenatal education; Self-confidence; Intranatal period
Every woman wants to become a queen at one stage without any restriction. It is the valuable event for the couple to get the future as parents. It is not about how often a woman gives birth, each pregnancy and delivery are unique and intimate experience in life. Childbirth is a multi-faceted task with physical, emotional, social, physiological, cultural and mental dimensions, which is reflect on a critical experience in every woman’s life .
Gestation takes about a great many variations in somatic, emotional and social aspects of life. First-time mothers have the added stressors of adopting to their new role as mothers and the uncertainties connected with their capacity to nurture a new-born for the first time, hence many women-if they have such the possibility-decide to contribute in childbirth education classes. The originator of the idea, Grantly Dick-Read. A British Obstetrician was the first one to perceive an association between the psychological state of the woman in labour and the pain
which accompanies childbearing. He defined that association
as the fear-tension-pain syndrome, which was the cause of pain
during labour [2,3].
Self-efficacy, viewed as an essential concept in nursing care
because it focuses the importance of authorising the patient.,
as well as self-management . According to Bandura, the
faith in one’s ability to cope with a specific task affects the hard
work invested in accomplishing the task. High self-efficacy
levels encourage the investment of considerable efforts toward
achieving goals and regulate the degree of effort and amount of
time to be invested in carry out the task in order to overcome the
difficulties . As a consequence of fear and anxiety, discharge
of stress hormones rises and can lead to preterm birth, lack
of progress, low birth weight of the child and fear hypoxia .
Women’s access to all health services, along with increased
awareness through education and counselling during pregnancy
and childbirth are captious effective factors in the anticipation
from mortality and stumbling block in this stage. Stimulation
of antenatal knowledge and ability makes mothers for delivery
and augment their health . In many portions of the Earth,
Antenatal and delivery drills that educate expectant women
and their partners about labour and parenthood is habitually
provided for females as part of antenatal care .
a) To assess the level of Self-Efficacy after Prenatal Self-
Efficacy Enhancing Educational Programme (SEEEP) among
Experimental group mothers during Intrapartum period.
b) To assess the level of Self-Efficacy among Control group
mothers during Intrapartum period.
c) To evaluate the effectiveness of Prenatal Self-Efficacy
Enhancing Educational Programme (SEEEP) on maternal
Self-Efficacy between the experimental group and the
control group mothers during Intrapartum period.
d) To associate the level of Self-Efficacy with the
selected demographic and obstetrical variables among the
experimental group mothers.
Research methodology is the fundamental procedure for
conducting the study. In order to achieve the objectives, a
quantitative research approach was found to be appropriate.
Research design used for this study was a quasi-experimental
post-test only with control group design and research variables
were maternal self-efficacy and prenatal Self-Efficacy Enhancing
Educational Programme. The study was conducted in Rajiv
Gandhi Government Women and Children hospital, Puducherry.
The population belonging to the prenatal mothers who
were admitted in antenatal ward with inclusion criteria. The
researcher had selected 90 Primigravidae and Nulliparas who
fulfilled the inclusion criteria as samples for this study. Among
them 8 subjects were become dropouts due to caesarean section
and with that 2 were from experiment group and 6 were from
The sample size was comprised of 82 (41 in experiment
and 41 in control group) mothers. Sampling technique was
used in this study was purposive sampling technique. Inclusion
criteria of sample were Primigravidae and Nullipara mothers
 Between 39- and 42-weeks’ gestation admitted in antenatal
ward  Admitted for safe confinement  Willing to participate
 Present during data collection [5,6] Able to understand Tamil
and English language. The tool description was divided into three
sections. Section A: This section contained of Demographic and
Obstetric variable profile include age, education, occupation,
income, religion, residence, type of family, gestational age, parity,
present health condition and duration of labour. Section B: This
section contained statements on Level of self-efficacy during
first and second stage was assessed using modified Nancy selfefficacy
inventory observational questionnaire. It has two parts.
Part 1 deals with self-efficacy for first stage of labour, it was a
five-point Likert scale containing 10 items describing about
the childbirth experiences, out of which 4 items have got direct
scoring and 6 items have got reverse scoring [6-10].
The scoring of each items implies: 1- Almost all the time,
2- A lot but not always, 3- About half the time, 4- Sometimes,
5- Never or almost never. The total score was between 10 and
50. Level of Self-Efficacy during First stage of labour was scored
as Low 10-20, Moderate 21-30, High 31-50. Part 2 deals with
Self-Efficacy expectancy for second stage of labour, it was a
numerical rating scale containing 10 items with score for each
item ranging from 1-5, describing the behavioural expectancies
during second stage of labour. Level of Self-Efficacy during
Second stage of labour was scored as Low 10-20, Moderate 21-
30, High 31-50. Section C: This section contained researcher
made checklist assessing third and fourth stage self-efficacy. it
was prepared by the researcher containing 8 items which were
expected after birth of the child. Among them 4 items have
got direct scoring and 4 items have got reverse scoring. Score
of 1 will be given if they perform and no score was given if not
performed (direct scoring). Score of 1 will be given if they not
perform and no score was given if performed (reverse scoring).
Level of Self-Efficacy during Third and fourth stage of labour was
scored as Low 0-2, Moderate 3-5, High 6-8. After completion of
pilot study, the researcher conducted the study from 27/8/2018
to 22/9/2018 at Rajiv Gandhi Government Women and Children
Hospital, Puducherry. Investigator obtained a formal permission
from institutional ethical committee for conducting the study.
The researcher introduced herself to the mothers. The purpose
of the study clearly stated to the mothers. Informed consent was
obtained from each mother in both oral and written form. The
mothers had the freedom to withdraw from the study at any
On each day, around 2-3 mothers were selected for
educational intervention for 45 minutes which consisted of
stages of labour, pre-preparation for labour, procedures carried
out in labour room, physiological changes and care during all
stages of labour and data were collected by using modified
standardised structured questionnaire on level of self-efficacy
among mothers. The same mothers were followed up and
observed during their second third and fourth stage of labour
using modified standardised structured questionnaire [11-16].
The results showed that in the experiment group, majority 25
(61%) mothers were in the age group of 22-25 years, 17 (41.5%)
mothers had Graduation in education, 38 (92.7%) mothers were
homemakers, 14 (34.1%) mothers were belonged to monthly
income more than Rs. 10000, 41 (100%) mothers were Hindu,
33 (80.5%) mothers were lived in nuclear family, 22 (53.7%)
mothers were in Rural residence, 41 (100%) mothers were not
attended childbirth preparation class. Whereas in the control
group, majority 20 (48.8%) mothers were in the age group of
22-25 years, 16 (39%) mothers had completed higher education,
39 (95.1%) mothers were homemakers, 14 (34.1%) mothers
were belonged to monthly income between7500-10000, 39
(95.1%) mothers were belonged to Hindu, 33 (80.5%) mothers
were lived in nuclear family, 22 (53.7%) mothers were in Rural
residence, 41 (100%) mothers were not attended childbirth
preparation class (Table 1).
The results predicted that in the experimental group,
Majority 39 (95.1%) mothers had high level of self-efficacy
when compared to control group 29 (70.7%) mothers who
had moderate level of self-efficacy during first stage of labour.During second stage of labour, 32 (78%) mothers had high level
of self-efficacy in experimental group and 33 (80.5%) mothers
had low level of self-efficacy. During third and fourth stage of
labour, 41 (100%) mothers who had high level of self-efficacy
in experimental group when compared with control group 35
(85.4%) mothers had moderate level of self-efficacy. So, the level
of self-efficacy had increased with experimental group than
control group mothers (Figure 1).
The results depicted that in the experiment group, the
mean score of self-Efficacy during latent phase of labour was
44.02±3.182. The mean score of self-Efficacy during second
stage of labour was 51.32±11.844 and the mean score of self-
Efficacy during third and fourth stage of labour was 8.00±0.000.
The total self-efficacy among experimental group was found
with the significance of t=20.088 (sig=0.000). Whereas with
the control group, the mean score of self-Efficacy during latent
phase of labour was 29.46±6.705. The mean score of self-Efficacy
during second stage of labour was 30.32±19.508 and the mean
score of self-Efficacy during third and fourth stage of labour was
2.49±1.625. The total self-efficacy among experimental group
was found with the significance of t=20.088 (sig=0.000) (Figure
The discussion of the study was positioned on the findings
from the statistical analysis of assessment of level of self-efficacy
between experiment and control group intrapartum mothers.
It was showed clearly that there was a significant difference
in the level of self-efficacy among experimental mothers than
the control group mothers. Therefore, it was implied that the
experimental group mothers’ level of self-efficacy was improved, and it was statistically proved. The present study was supported
by authors said that the core relationship was examined by Lowe
between perception of self-efficacy in coping with childbirth and
the fears related to childbirth among nulliparous women. She
found an inverse relationship between the levels of self-efficacy
and the levels of fear related to childbirth.
Similar results were also observed in the studies conducted
by Reck & Beebe. who found a significant positive correlation
between the overall anxiety level and birth related anxiety, a
significant negative correlation between the anxiety level and
self-efficacy level in coping with child birth and a significant
negative correlation between ways of coping with the child
birth process in the study of the Effect of childbirth preparation
courses on anxiety and self-efficacy in coping with childbirth.
The study was supported by the study conducted by David Yohai
found significantly shorter duration during entire duration of
labour (p=0.026) in the study of effect of attending a prenatal
childbirth preparedness course on labour duration and
outcomes. The study was supported by the study conducted by
Gozde Gokce Isbir found improved self-efficacy with imparting
antenatal education with highly significant (p<0.05) in study of
the effects of antenatal education on fear of childbirth, maternal
self-efficacy and post-traumatic stress disorder symptoms
The above study results highlighted and proved statistically
that Prenatal Self-Efficacy Enhancing Educational Program was
found to be effective in reducing fear and enhance individual’s
self-efficacy during intrapartum period through the difference
in the level of self-efficacy among experiment and control group
which ultimately reduces caesarean section and indirectly
reducing morbidity and mortality rate of mothers. So, this
method of teaching programme on self-efficacy among the
intrapartum mothers can be promoted in prenatally by nurse in
their day to day activities in hospital settings.