ABSTRACT Title of dissertation: THE DEVELOPMENT OF MATERNAL CONFIDENCE FOR LABOR AMONG NULLIPAROUS PREGNANT WOMEN

Title of dissertation: THE DEVELOPMENT OF MATERNAL CONFIDENCE FOR LABOR AMONG NULLIPAROUS PREGNANT WOMEN Julia Ann Kish, Doctor of Philosophy, 2003 Dissertation directed by: Robin G. Sawyer, Ph.D. Department of Public Health and Community Health Certain levels of fear and anxiety about childbirth are expected, especially among first-time mothers. However, problems arise when these feelings negatively impact a woman's decisions and perceptions about the birth process. Although millions of women give birth each year, there are limited data to document the development of maternal confidence for labor and fear of labor throughout the period of gestation. Applying Bandura's theory of self-efficacy, current research on maternal confidence for labor suggests women with increased childbirth self-efficacy experience decreased levels of perceived pain and increased levels of satisfaction with birth. The purpose of this quasi-experimental, multi-time series research study was to examine the development of maternal confidence for labor among nulliparous pregnant women throughout gestation. The following primary research question was addressed: Does maternal confidence for labor actually increase (i.e., fear decrease) as pregnancy progresses? Other research variables indicated in the literature to have an impact on maternal confidence were examined including prenatal care provider (physicians and midwives), attendance at a childbirth class, perceived childbirth knowledge, emotional support and importance of a medicine-free birth. A convenience sample of 46 nulliparous women completed three mail questionnaires (one at 8-12 weeks of gestation, 28 weeks, and 37 weeks) and a postpartum telephone interview. All three mail questionnaires were similar in content and contained two scales, the Maternal Confidence scale and the Fear of Childbirth scale. Data was collected from August, 2001 through June, 2003. A significant inverse relationship between maternal confidence for labor and fear of childbirth was found throughout gestation. Other major findings of this study included: 1) a significant positive relationship between perceived knowledge and maternal confidence, and 2) increased fear among women who initially seek midwiferybased prenatal care at 8-12 weeks of pregnancy. The type of prenatal care a woman obtains (midwifery-care or physician-based care) did not significantly impact her confidence for delivery or fear of childbirth. It is recommended future studies examine the role of self-efficacy with regard to childbirth in greater depth for nulliparous women throughout gestation or prior to pregnancy. THE DEVELOPMENT OF MATERNAL CONFIDENCE FOR LABOR AMONG NULLIPAROUS PREGNANT WOMEN