In Turkey, the increasing cesarean section (C/S) ratio is a universal problem. Especially in the southeastern region and in lower social economics part of Turkey, C/S ratio is raised steadily. Although the epidural vaginal delivery protocol, the lack of practical experience of anesthesia and the overcrowded hospitals limit the capability of epidural anesthesia. In contrast to European and American hospitals, the cost of C/S does not differ in Turkey even though in private hospitals from the Normal Vaginal Delivery (NVD). For this reason, the increased elective C/S ratio can’t be decreased especially in primary pregnancy. The fear of vaginal delivery that is emphasized with cultural factors is a nightmare in pregnant women. The satisfaction of pregnancy and the being a mother or family is not considered. Poor emotional health is associated with increasing childbirth fear and risk of depression, birth trauma and inability to interact positively with the baby and meet infant development needs and can be a stressor in couple relationship [1-11]. By the improvement of technology, social media aggravated this fear with some videos of normal vaginal delivery.

In obstetric clinics at Mersin Sehir Hospital, we try to give education about fertilization of ovum, normal physiology of pregnancy, the changing of body, feelings and mood, the physiology of delivery, the care and feeding of the baby by mid-wive intervention and the opportunity of plates with the coach. The aim of this organization to emphasize the nature of vaginal birth and the capability of mother vaginal delivery with less fear, more controlled body and the knowledge about delivery and baby. This midwives intervention was done in 3 sessions and pilates in 6 sessions in whole 9 months.

This study is a retrospective case-control study among women that visit obstetric clinics in Mersin Sehir Hospital, Turkey. The case and control groups have been chosen randomly. The first goal is the measurement of fear about vaginal birth, and the preferred mode of delivery before and after the midwife intervention. The tendency to the C/S because of fearful pregnant women may be decreased by midwife intervention. The pregnant women with childbirth fear more often prefer a C/S [12-14]. Not only the lowering C/S ratio is our goal, but also the satisfaction of pregnancy, vaginal delivery and lowering flashback are in our first goal. The maternity is a sacred phase of a human being and it shouldn’t be interrupted with unsatisfied experience in delivery. A secondary goal of our study was the number of visitors to the obstetric clinic in the postpartum period. The mother wonders that something is wrong with the baby or herself because of unsatisfied delivery. The effective and continuation of breastfeeding, the programming of future pregnancy in the first month and the planning of the next pregnancy with normal vaginal delivery are also secondary goals. In fact, unsatisfied delivery causes bad flashback which is the reason for discontinuation of breastfeeding. The planning of the next pregnancy in the puerperal period with vaginal delivery is affected with a bad experience. Even though the future pregnancy is planned as C/S.

This is retrospective case-control study with a sample size of 482 pregnant women in the case group and 949 pregnant women in the control group. All the women were in their first pregnancies. 12 women from case group discontinued the education and 42 women undergone C/S because of fetal distress or cephalopelvik disproportion. 8 women from the case group were unreachable after the delivery. In the control group, 23 women were excluded because of cholestasis and preeclampsia, 43 patients were lost during pregnancy or postpartum period. 12 women refused the filling of WDEQ-A questionnaire.

To summarize; the pregnant women between 16-40 years of age were included in the study. Those women were integrated into midwife intervention in 3 sessions and 3-6 times pilates sessions with a coach in obstetric clinics of Mersin Sehir Hospital.

Data collection and measurements

To complete the questionnaire about demographic characteristics women were asked. The WDEQ-A was used to measure the antenatal childbirth fear [15]. Women scoring high childbirth fear (>66) were randomized to the case and control group [16]. Another midwife intervention was done after 1 month of delivery in case and control groups.

Statistical analysis

The study was a retrospective case-control study among patients in the obstetric clinics, at Mersin Sehir Hospital. The data were analyzed with SPSS (Statistical Package for Social Sciences) for Windows 22.0 programmer.

The analysis of data was delineated in numbers and percentages. The relation between the group variations was analyzed Chi-square test.

Findings

Being pregnant, giving birth, the care of the baby, is emotional stress for mother beside the number of pregnancy. In this study, we believe that the education and recall of information help the mother to relax and get rid of the fear of giving birth. The vaginal delivery flashback and influence on a future pregnancy, route of delivery were aimed to be positively changed.

This study showed that the information, education, and pilates sessions had a role on the feeling of the mother during pregnancy, delivery, route of birth even though after birth for caring of the baby, feeding, and satisfaction as a mother. However, the Psychoeducation encourages women, for decreasing cesarean delivery numbers which is not an option.

The estimated childbirth fear is 6-10% of all pregnancy which is common among the nulliparous as in parous [17-20]. This study is the measurements of subjective findings. The absence of recall and the analysis of emotion will cause the biases to some degree. But the bad experience during the pregnancy and delivery may affect the whole women’s life. We try to standardize the education programmer for pregnant women to increase the Normal Vaginal Delivery (NVD) numbers, be satisfied from pregnancy and NVD, to reduce the unnecessary recurrent visit of obstetric clinics, to encourage breastfeeding, to support families for their future pregnancy.

The study determined that the educational programmer may encourage the pregnant women in the delivery room (as shown in Table 1). Instead, the cesarean ratio didn’t change especially in planned pregnancy. Especially in planned pregnancy, the delivery route was chosen as cesarean section even in educated pregnant women. Besides, the midwife intervention satisfied women from pregnancy period and NVD (Tables 2 and 3). Women felt being mother during delivery by comparing with control groups. The nightmare or flashback recall during one month of puerperium was decreased by midwife intervention (Table 4). For this reason, the traumatic part of the delivery and pregnancy was regreded by the educational programmer.

Table 1: The comparison of the normal vaginal delivery ratio between groups.

Table 2: The satisfaction from the pregnancy in case and control groups.

Table 3: The satisfaction from normal vaginal delivery.

Table 4: The flashback of normal vaginal delivery.

In the control group, the recurrent unnecessary obstetric clinic visit was detected because of questions about delivery and baby (Table 5). In those visit, the emotionally unsatisfied, scarred and doubtful mother’s was observed. By means of midwife intervention, those traumatic factors were elected and happy mothers with happy babies were created. The emotional satisfaction affects the breastfeeding positively, in the educated pregnant women the future plan and the happiness of being a mother were shown by the high ratio of planning next pregnancy in contrast to control group (Tables 6 and 7). Interestingly, the C/S ratio was not affected by the education; it was certain that even though midwife intervention did not positively raise the desire for normal vaginal delivery (Table 8).

Table 5: The recurrent visit to the obstetric clinic.

Table 6: The ratio of breastfeeding.

Table 7: The planning of future pregnancy.

Table 8: The preferring c/s in planned pregnancy.

Surely, the case group didn’t want to undergo NVD in the next pregnancy. The reason for this may be, although the education, traumatic pain of delivery which wasn’t decreased by the midwife intervention. Besides the positive effect of an educational programmer, the reality of normal vaginal delivery may have negative consequences.

Midwife intervention should be professionally given to all pregnant women to encourage women for healthy mothers and babies but the C/S rate shouldn’t be designed by the educational programmer.