Document Type : Original Article
Authors
Department of Midwifery, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract
BACKGROUND: Negative attitudes toward vaginal delivery are an important reason for pregnant
women to undergo a cesarean section. Therefore, this study was performed to evaluate the effect
of motivational interviewing on attitude and choice of primigravida women on type of delivery in
requesting elective cesarean section.
MATERIALS AND METHODS: In this single‑blind clinical trial, 120 primigravida women in
28–31 weeks of gestation with normal pregnancy determined by a multistage sampling were randomly
chosen from ten health centers of Zahedan city in 2019 and were divided into two groups. Motivational
interviewing was performed in four sessions within 90 min in the experimental group, and the
control group received routine care service. Attitude (before and 1 month after the intervention) and
performance (after delivery) were evaluated using a valid and reliable researcher‑made questionnaire.
The collected data were analyzed using different proportions, paired t‑test, independent t‑test,
covariance analysis, and Shapiro–Wilk and the Chi‑square methods.
RESULTS: There was a significant difference in the attitude of participants between the two groups
after the intervention (P = 0.001). The mean difference of pre‑ and posttest was significant in relation
to attitude scores in the two groups (P = 0.001), and the difference between the two groups was also
statistically significant between the two groups in terms of delivery type (P = 0.03).
CONCLUSION: We conclude that motivational interviewing can be a useful tool to change the attitude
and decrease the rate of unnecessary cesarean among pregnant women. It is recommended to
examine the impact of this method on women from different societies who have various educational
backgrounds and cultures.
Keywords
- Sharifirad GR, Fathian Z, Tirani M, Mahaki B. Study on behavioral
intention model (BIM) to the attitude of pregnant women
toward normal delivery and cesarean section in province of
Esfahan‑Khomeiny Shahr‑1385. Journal of Ilam University of
Medical Sciences. 2007: 15 (1): 19‑23
2. Garmaroudi G, Eftekhar H, Batebi A. Factors that affect cesarean
among pregnant women. Payesh J 2002;1:45‑9.
3. Afshari A, Ghafari M. A survey on selection of delivery method
by nulliparous pregnant women using health belief model in
Semirom, Iran, 2012. Iran J Obstet Gynecol Infertil 2013;16:22‑9.
4. Shakeri M, Mazloumzade S, Mohamaian F. Factors affecting the
rate of cesarean section in Zanjan maternity hospitals in 2008.
ZUMS J 2012;20:98‑104.
5. Badakhsh MH, Seifoddin M, Khodakarami N, Gholami R,
Moghimi S. Rise in cesarean section rate over a 30‑year period in
a public hospital in Tehran, Iran. Arch Iran Med 2012;15:4‑7.
6. Azami‑Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M,
Asl Amin Abad R. Prevalence and causes of cesarean section in
Iran: Systematic review and meta‑analysis. Iran J Public Health
2014;43:545‑55.
7. Darvishi E, Mortazavi S, Nedjat S, Naieni KH. Experiences of
women and gynecologists on the choice of delivery method:
A qualitative research. J Health Syst Res 2012;8:59‑68.
8. Bahonar A, Shaebani A, Aghajani M. Determinants of cesarean
and its trend in Damghan, Iran. Iran J Epidemiol 2010;6 (1):33‑8.
9. Macones G. Clinical outcomes in VBAC attempts: What to say to
patients? Obstet Anesth Dig 2009;29:9‑10.
10. Sharifirad G, Fathian Z. Survey of pregnant women view than
vaginal and cesarean delivery based on behavioral intention
model. J Illam Univ Med Sci 2007;1:19‑23.
11. Etghaee M, Noohi A, Khajepoor M. Investigating the attitude
towards labor pain and choose the mode of delivery in pregnant
women referred to health care centers in Kerman. J Nurs
Midwifery Kerman 2009;41:10‑36.
12. Fisher C, Hauck Y, Fenwick J. How social context impacts on
women’s fears of childbirth: A Western Australian example. Soc
Sci Med 2006;63:64‑75.
13. Amidi M, Akbarzadeh K. The effects of health education on
pregnant woman’s knowledge and attitude on cesarean section.
J Ilam Univ Med Sci 2005;13:17‑25.
14. Fathian Z, Sharifirad GR, Hasanzadeh A, Fathian Z. Study of
the effects of behavioral intention model education on reducing
the cesarean rate among pregnant women of Khomeiny‑Shahr,
Isfahan, in 2006. Zahedan Journal of Research In Medical
Sciences (Tabib‑E‑Shargh): 2007: 9 (2):123‑131.
15. Bani S, Rasouli AS, Shams TG, Ghoojazadeh M, Poor SH.
Preferrenced perpetrators of delivery about their delivery and
type of delivery offered to pregnant women. J Nurs Midwifery
Tabriz 2012;5:629‑35. - 16. Bagheri A, Masudi N, Zade FA. Determine factors of influencing
choice of delivery by pregnant women in Kashan city. J Sci Res
Faiz 2011;2:146‑53.
17. Gee RE, Corry MP. Patient engagement and shared decision
making in maternity care. Obstet Gynecol 2012;120:995‑7.
18. Escott D, Slade P, Spiby H. Preparation for pain management
during childbirth: The psychological aspects of coping
strategy development in antenatal education. Clin Psychol Rev
2009;29:617‑22.
19. Ghazaie M, Davoodi I, Neysi A, Honarmand MM, Nejad SB. The
effectiveness of cognitive‑behavioral therapy on fear of childbirth,
fear of pain, self‑efficacy of childbirth and tendency to caesarean
in nulliparous women. Iran J Obstet Gynecol Infertil 2016;19:1‑12.
20. Rollnick S, Miller WR, Butler CC, Aloia MS. Motivational
Interviewing in Health Care: Helping Patients Change Behavior.
Vol 5.: Taylor and Francis; 2008. p. 203.
21. Rollnick S. Motivational Interviewing: Preparing People for
Change. English: 2nd ed. New York: Guilford Press; 2002.
22. Martins RK, McNeil DW. Review of motivational interviewing
in promoting health behaviors. Clin Psychol Rev 2009;29:283‑93.
23. NaiduR, Nunn J, Irwin JD. The effect of motivational interviewing
on oral healthcare knowledge, attitudes and behaviour of parents
and caregivers of preschool children: An exploratory cluster
randomised controlled study. BMC Oral Health 2015;15:101.
24. Walpole B, Dettmer E, Morrongiello BA, McCrindle BW,
Hamilton J. Motivational interviewing to enhance self‑efficacy
and promote weight loss in overweight and obese adolescents:
A randomized controlled trial. J Pediatr Psychol 2013;38:944‑53.
25. Solomon DH, Iversen MD, Avorn J, Gleeson T, Brookhart MA,
Patrick AR, et al. Osteoporosis telephonic intervention to improve
medication regimen adherence: A large, pragmatic, randomized
controlled trial. Arch Intern Med 2012;172:477‑83.
26. Rasouli M, Sokhan GA, Keramat A, Khosravi A, Fooladi E,
Mousavi SA. The impact of motivational interviewing on
participation in childbirth preparation classes and having a
natural delivery: A randomised trial. BJOG 2017;124:631‑9.
27. Ghasemi H, Heidary H, Ghasemi N, Dehghani S. The evaluation
of the effectiveness of motivational interviewing on lifestyle
changes in female addicts under way for recovery. Res Addict
2015;8:25‑34.
28. Sanavi FS, Navidian A, Rakhshani F, Ansari‑Moghaddam A. The
effect of education on base the theory of planned behavior toward
normal delivery in pregnant women with intention elective
cesarean. Bimonthly J Hormozgan Univ Med Sci 2014;17:531‑9.
29. Abedian Z, Navaee M, Sani HJ, Arani A, Ebrahimzadeh S.
Comparing the effect of two teaching methods, role playing
and lecture on Primigravida women’s knowledge, attitude and
performance according to delivery mode. Iran J Obstet Gynecol
Infertil 2012;15:26‑34.
30. Gingrich AM. Effects of Motivational Interviewing on Improving
Attitude toward Exercise in College Students; 2008.
31. Besharati F, Hazavehei S, Moeini B, Moghimbeigi A. Effect
of educational interventions based on theory of planned
behavior (TPB) in selecting delivery mode among pregnant
women referred to Rasht health centers. ZUMS 2011;19:94‑106.
32. Toughyani R, Ramezani MA, Izadi M, Shahidi S, Aghdak P,
Motie Z, et al. The effect of prenatal care group education on
pregnant mothers’ knowledge, attitude and practice. Iran J Med
Educ 2008;7:317‑24.
33. Kazemzadeh M, Pouralajal J, Ghazanfarzadeh B, Ghahramani M.
Promotion of safe labor through training healthcare workers and
pregnant women to reduce cesarean rate in Malayer (2004‑2005).
J Med Counc Islam Repub Iran 2007;25:149‑53.
34. Saisto T, Toivanen R, Salmela‑Aro K, Halmesmäki E. Therapeutic
group psychoeducation and relaxation in treating fear of
childbirth. Acta Obstet Gynecol Scand 2006;85:1315‑9.
35. Ghaffari M, Sharifirad G, Akbari Z, Khorsandi M, Hassanzadeh A.
The health belief model based education and reducation of
cesarean among pregnant women: An interventional study.
Health Syst Res 2011;7:200‑8.
36. Navaee M, Abedian Z. Effect of role play education on
primiparous women’s fear of natural delivery and their decision
on the mode of delivery. Iran J Nurs Midwifery Res 2015;20:40‑6.
37. DiIorio C, Resnicow K, McDonnell M, Soet J, McCarty F, Yeager K.
Using motivational interviewing to promote adherence to
antiretroviral medications: A pilot study. J Assoc Nurses AIDS
Care 2003;14:52‑62.
38. Wilhelm SL, Stepans MB, Hertzog M, Rodehorst TK, Gardner P.
Motivational interviewing to promote sustained breastfeeding.
J Obstet Gynecol Neonatal Nurs 2006;35:340‑8.
39. Gibbons L, Belizan JM, LauerJA, Betran AP, Merialdi M, Althabe F.
The global numbers and costs of additionally needed and unnecessary
caesarean sections performed per year: Overuse as a barrier to
universal coverage. World Health Rep 2010;30:1‑31.
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