Effect of Solution-focused Approach Training on Traumatic Birth Perception, Vaginal Birth Self-efficacy, Birth Choice

Overview

Women's psycho-social health during pregnancy could influence the course of pregnancy, psychological and emotional life, not only in labor but also during the postpartum period. Women's perception of birth and their self-efficacy may affect the birth and postpartum period, and their delivery preference. The study aims to examine the effect of solution-oriented approach training on traumatic birth perception, vaginal birth selfefficacy, and delivery preference. It was designed in a randomized controlled experimental type. The sample in the study will comprise 80 pregnant women (40 experimental and 40 control groups) with the help of power analysis. The study is going to be conducted with pregnant women applying to KTU Farabi Hospital between May and December 2022. 6-8 sessions of solution-oriented approach training will be given to pregnant women with 28 weeks of gestation and above and willing to take part in the study, and their delivery preferences will be examined, afterward. The pregnant women in the control group, on the other hand, will not be subjected to any training or interview other than routine pregnancy follow-ups. Data will be gathered through the Pregnant introductory information form, traumatic birth perception scale form, and vaginal birth self-efficacy form. Ethics Committee Permission, institutional permission from the institution where the research will be conducted, and written informed consent from the mothers will be obtained before the research. The data will be statistically evaluated through the SPSS 23 program. Student t-test or Mann-Whitney U tests will be applied for two independent groups. One A Way or Kruskal-Wallis tests will be applied for three or more independent groups, depending on whether the data meet the parametric conditions. Paired T or Wilcoxon tests will be used for two dependent groups, and Friedman or Repeat Measure tests will be applied for three or more groups. In statistical evaluation, p\<0.05 will be considered significant.

Pregnancy, birth and postpartum period; It is one of the most special behaviors of women. In this period when the woman plays a very important role after intercourse, her psychological health status can have an impact on her psychological and emotional life, including the course of pregnancy, birth and the period after birth.Sociodemographic characteristics, previous pregnancy or birth history, pregnancy and birth information obtained through hearsay, information obtained from unreliable sources, low health literacy level, not being able to receive adequate and effective prenatal care, and being in your first pregnancy are some of the factors that affect the psychosocial health of women.Although birth, which is the result of pregnancy, is a normal and physiological process, it is one of the unique experiences that affects the woman physically, psychologically and socially and causes significant changes in her life. Although birth is under the influence of all processes of a woman's life, it is especially closely related to how the pregnancy goes and how it is perceived. Although cesarean birth is a preferred method of birth only when vaginal birth is contraindicated or unsafe, this method of birth may be preferred by women for reasons such as the perception of traumatic birth and low self-efficacy for vaginal birth. When we look at the cesarean section rates in live births, it is seen that the total cesarean section rate, which was 48.0% in 2014, increased to 54.4% in 2019 . In our country, where the prenatal care rate is 98%, the fact that cesarean section rates are at such high levels poses a risk for mother-child and public health. Caesarean section birth, which is life-saving in case of medical necessity, increases the maternal morbidity and mortality rate by 2-4 times compared to vaginal births when performed off-label. Also, birth by cesarean section; It poses a risk in situations such as mother-baby bonding, starting and continuing breastfeeding, postpartum recovery and returning to daily life after discharge. Psychosocial and cognitive factors such as a negative past birth experience, negative birth stories, low self-efficacy for vaginal birth, and perceiving birth as traumatic play a role in women's preference for cesarean delivery. In a study conducted with 384 pregnant women in Trabzon province, 56.8% of these pregnant women perceived the birth as moderately traumatic, and 27.1% as highly traumatic. Birth is perceived as traumatic; It may be caused by situations such as fear of birth and low self-efficacy towards birth. Lack of knowledge about birth, labor pain, having a first birth, pain during birth, and inability to cope with the situations encountered cause an increase in the fear of birth and a decrease in birth self-efficacy in these pregnant women. Self-efficacy in birth is defined as "the woman's ability to see in herself the power to cope with the act of birth and her confidence in her abilities". The concept of self-efficacy is a subjective concept, and the level of self-efficacy can also affect the labor process and the fear of birth and therefore the perception of birth as traumatic. Another phenomenon that affects the birth process and the choice of birth method is the "perception of traumatic birth". The perception of traumatic birth is defined as the woman's perception of the birth process as a risk of injury and/or death for herself and her baby. Perception of birth as traumatic can cause depression, increased fear of birth, and negative birth experience in pregnant women.In order for the pregnancy, birth and postpartum period not to deviate from its naturalness and to be completed in a physiologically and psychosocially healthy way, support can be provided to the process through birth preparation classes and various prenatal trainings given to expectant parents. It has been determined that prenatal education given to pregnant women in the third trimester reduces the fear of birth and negative perceptions about birth.The training given to pregnant women by health professionals such as midwives, obstetricians and nurses during the antental period contributes to increasing the pregnant woman's health awareness, increasing her ability to cope with problems related to pregnancy and birth, strengthening her self-efficacy for vaginal birth, and having a positive birth experience. Solution-oriented approach training is of particular importance in helping pregnant women cope with their problems, perceiving pregnancy and birth, and protecting and improving their mental health.Solution-focused approach training is a type of counseling practice called "brief therapy" that was developed under the leadership of Steve de Shazer and Insoo Kim Berg between 1970 and 1980. The aim of this training is to try to solve the individual's basic problems with a short and pragmatic approach and to help the client determine the goal they want to achieve. In solution-focused approach training, unlike classical psychotherapy methods, the focus is on the "solution" instead of the "problem" and the person's past successes, good and strong aspects in his life are emphasized instead of dealing with the problem itself. It focuses on the strengths of the person being trained and the things they want to achieve, and emphasizes that the solution to the problem will come from the person himself and that his self-confidence will increase as a result. In other words, it aims to increase the individual's self-confidence and self-efficacy. One of the most important features of this training is that it provides effectiveness in a short time and lasts 6-10 sessions.