Self-Efficacy in Pregnant Women with Severe Fear of Childbirth

Objective To apply and test the concept of childbirth self-efficacy to expectations of the upcoming birth in the context of severe fear of childbirth (SFOC). Design Qualitative study using semistructured interviews. Setting A region in the southeast of Sweden. Participants Nulliparous pregnant women (N=17) with SFOC. Method The interviews were analyzed according to content analysis using deductive and inductive approaches. The seven domains of The Childbirth Self-Efficacy Inventory (CBSEI) made up the matrix for the deductive analysis. Results Behaviors for coping with labor and childbirth were related to six domains of childbirth self-efficacy: concentration, support, control, motor/relaxation, self-encouragement, and breathing. Most of these behaviors referred to capabilities to carry out (self-efficacy expectancy) rather than to beliefs in effectiveness (outcome expectancy). Five additional subdomains representing defined childbirth self-efficacy were identified: guidance, the body controls, the professionals' control, reliance, and fatalism. Conclusion The domains of childbirth self-efficacy have been deepened and expanded in relation to SFOC. It is imperative to identify pregnant women with SFOC and their efficacy beliefs to help them find appropriate coping behaviors prior to the onset of labor, and furthermore these behaviors must be supported by health care professionals during labor and childbirth. Support in the form of verbal persuasion emanating from the subdomains of childbirth self-efficacy ought to be added.