Individual and Group Psycho-Educational Counseling on Knowledge, Attitude and Preference for Birth Method in Nulliparous Women: A Randomized Controlled Trial

  • Mahnaz Nosratabadi Department of Midwifery, Faculty of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
  • Khadija Hekmat Department of Midwifery, Faculty of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
  • Anna Dencker Reproductive and Perinatal Health, Centre for Person-Centered Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Zahra Abbaspoor Mail Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Counseling, Knowledge, Attitude, Birth Method Selection


Objective: To study the effects of the Individual and Group Psycho-educational counseling in pregnant women on knowledge, attitude and mode of delivery.Materials and methods: This is a randomized controlled trial that carried out on 100 healthy nulliparous pregnant women with uncomplicated pregnancies, who had no contraindication for vaginal birth, but opted for a caesarean section in Medical centers of Dezful city, in the south west of Iran. Participants were randomly assigned into individual or group psycho-educational counseling from gestational week 20 and Knowledge, attitude and mode of delivery in the Individual and Group Psycho-educational counseling methods were measured.Results: All the participants (100%) in the individual and a majority (92%) in the group counseling changed their preference for birth method to vaginal birth after the counseling intervention. Baseline mean scores of knowledge and attitude into birth method selection were equal between groups. After the counseling intervention the mean scores increased significantly for knowledge in both the individual and group counseling groups: 12.96 and 12.88 before the intervention to 24.16 and 22.62, respectively (p < 0.001). Likewise attitude mean scores increased in both groups: 116.06 and 123.42, respectively, before the counseling sessions, that changed to 170.12 and 160.36 after the counseling sessions (p < 0.001). The differences in knowledge and attitude mean scores were statistically non-significant between groups after the intervention.Conclusion: The individual as well as the group psycho-educational counseling sessions increased the knowledge and attitude of pregnant women in relation to vaginal birth without significant differences between groups. Both methods can be recommended. A group counseling method is more effective for advising on the choice of delivery method when many women request a caesarean section without medical indications.  



Atghaee M, Nouhi E. The effect of imagination of the pain of vaginal delivery and cesarean section on the selection of normal vaginal delivery in pregnant women attending clinics in Kerman university of medical sciences. The Iranian journal of obstetrics, gynecology and infertility. 2012;14(7):44-50.

GHAFFARI M, SHARIFIRAD G, AKBARI Z, KHORSANDI M, HASSANZADEH A. Health belief model-based education & reduction of cesarean among pregnant women: An interventional study. 2011.

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. 2007.

Farr SL, Jamieson DJ, Rivera HV, Ahmed Y, Heilig CM. Risk factors for cesarean delivery among Puerto Rican women. Obstetrics & Gynecology. 2007;109(6):1351-7.

Minkoff H, Chervenak FA. Elective primary cesarean delivery. New England Journal of Medicine. 2003;348(10):946-50.

MOHAMMADI TS, KIANI AA, HEYDARI M. The survey on tendencies of primiparous women for selecting the mode of delivery. 2009.

Pallasmaa N, Ekblad U, Gissler M. Severe maternal morbidity and the mode of delivery. Acta obstetricia et gynecologica Scandinavica. 2008;87(6):662-8.

Nieminen K, Stephansson O, Ryding EL. Women's fear of childbirth and preference for cesarean section–a cross‐sectional study at various stages of pregnancy in Sweden. Acta obstetricia et gynecologica Scandinavica. 2009;88(7):807-13.

Shorten A, Chamberlain M, Shorten B, Kariminia A. Making choices for childbirth: development and testing of a decision-aid for women who have experienced previous caesarean. Patient education and counseling. 2004;52(3):307-13.

Liu NH, Mazzoni A, Zamberlin N, Colomar M, Chang OH, Arnaud L, et al. Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study. Reproductive health. 2013;10(1):2.

Shahshahan Z, Heshmati B, Akbari M, Sabet F. Caesarean section in Iran. The Lancet. 2016;388(10039):29-30.

Boskabadi H, Zakerihamidi M, Bagheri F. Outcomes of vaginal delivery and cesarean in Mashhad Ghaem University Hospital. Tehran University Medical Journal TUMS Publications. 2014;71(12):807-15.

Tavassoli A, Kalari F, Dizji AZ. Social Factors affecting Cesarean Trend in pregnant women. Medical Ethics Journal. 2015;8(29):145-70.

Rouhe H, Salmela‐Aro K, Toivanen R, Tokola M, Halmesmäki E, Saisto T. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women–randomised trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2013;120(1):75-84.

Tofighi Niaki M, Behmanesh F, Mashmuli F, Azimi H. The effect of prenatal group education on knowledge, attitude and selection of delivery type in primiparous women. Iranian Journal of Medical Education. 2010;10(2):124-30.

Ghooshchian S, Dehghani M, Khorsandi M, Farzad V. The role of fear of pain and related psychological variables in prediction of cesarean labor. Arak Uni Med Sci J. 2011;14(56):45-54.

Abbaspoor Z, Moghaddam-Banaem L, Ahmadi F, Kazemnejad A. Iranian mothers' selection of a birth method in the context of perceived norms: A content analysis study. Midwifery. 2014;30(7):804-9.

Abbaspoor Z, Moghaddam-Banaem L, Ahmadi F, Kazemnejad Lili A. Postnatal Sexual Concerns Regarding the Selection of Delivery Mode among Iranian Women: A Qualitative Content Analysis. Journal of Midwifery and Reproductive Health. 2016;4(2):613-21.

Edwards PB. Leisure counseling techniques: Individual and group counseling step-by-step. 1980.

Forsyth DR. Group dynamics: Cengage Learning; 2009.

Consonni EB, Calderon IM, Consonni M, De Conti MH, Prevedel TT, Rudge MV. A multidisciplinary program of preparation for childbirth and motherhood: maternal anxiety and perinatal outcomes. Reproductive health. 2010;7(1):28.

Delaram M, Soltanpour F. The effect of counseling in third trimester on anxiety of nulliparous women at the time of admission for labor. Zahedan Journal of Research in Medical Sciences. 2012;14(2):61-5.

Abedian Z, Navaee M, Sani HJ, Ebrahimzadeh S. Comparing two instructional methods of role playing and lecture on primigravida females, decision about type of delivery. Journal of Education and Health Promotion. 2017;6.

Akbari SAA, Bahrami N, Tork-Zahrani S, Alavi-Majd H. Knowledge and attitude of pregnant women regarding mode of delivery in women referring to Dezful health centers. Advances in Nursing & Midwifery. 2008;18(63).

Blonna R, Watter D. Health counseling: A microskills approach: Jones & Bartlett Learning; 2005.

Geldard D, Geldard K. Basic Personal Counseling. Sydney, NSW: Pearson Education; 2005.

Malakouti j, Alidoost n, Mohaddesi h, Sattarzadeh Jahdi n, Asghari Jafarabadi m, Salehi Pourmehr h. The evaluating effect of education on knowledge and attitude of nulliparous women toward the delivery method. Journal of Urmia Nursing And Midwifery Faculty. 2014;12(7):575-68.

Lashgari M, Delavari S, Markazi MN, Gorouhi F. Effects of training programs of pregnant women on their delivery type selection: A single blind, randomized control trial. 2005.

Saisto T, Halmesmäki E. Fear of childbirth can be treated, and cesarean section on maternal request avoided. Taylor & Francis; 2007.

Artieta-Pinedo I, Paz-Pascual C, Grandes G, Remiro-Fernandezdegamboa G, Odriozola-Hermosilla I, Bacigalupe A, et al. The benefits of antenatal education for the childbirth process in Spain. Nursing research. 2010;59(3):194-202.

Shahraki Sanavi F, 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 Journal of Hormozgan University of Medical Sciences. 2014;17(6):531-9.

Khan-Jeihooni A, Shahidi F, Kashfi SM. Effectiveness of Educational Program Based on the Theory of Reasoned Action to Decrease the Rate of Cesarean Delivery Among Pregnant Women in Fasa, Southern Iran. J Educ Community Health. 2014;1(1):62-71.

Sydsjö G, Bladh M, Lilliecreutz C, Persson A-M, Vyöni H, Josefsson A. Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth-a retrospective case control study. BMC pregnancy and childbirth. 2014;14(1):126.

How to Cite
Nosratabadi M, Hekmat K, Dencker A, Abbaspoor Z. Individual and Group Psycho-Educational Counseling on Knowledge, Attitude and Preference for Birth Method in Nulliparous Women: A Randomized Controlled Trial. J Fam Reprod Health. 12(2):103-110.
Original Articles