Antenatal Education, Fear of Childbirth, Pregnancy
Conditions
Keywords
Antenatal perineal massage, Midwife-led education, Primiparous pregnant women, Pregnancy empowerment, Self-efficacy for normal birth, Fear of childbirth, Vaginal birth, Pelvic health, Routine antenatal care
Brief summary
This study aims to evaluate the effect of midwife-led antenatal perineal massage education on pregnancy empowerment, self-efficacy for normal birth, and fear of childbirth among primiparous pregnant women. The study is designed as a controlled quasi-experimental study and will be conducted at the Obstetrics and Gynecology Outpatient Clinic of Silifke State Hospital in Mersin, Turkey. Eligible participants will be primiparous pregnant women aged 18-35 years, between 28 and 34 weeks of gestation, with a singleton pregnancy and a plan for vaginal birth. Participants in the intervention group will receive structured antenatal perineal massage education led by a midwife, in addition to routine antenatal care. Participants in the control group will receive routine antenatal care. The primary outcome will be pregnancy empowerment. Secondary outcomes will include self-efficacy for normal birth, fear of childbirth, knowledge and preferences regarding antenatal perineal massage, and adherence to antenatal perineal massage practice.
Detailed description
This controlled quasi-experimental study will evaluate the effect of a structured midwife-led antenatal perineal massage education program on pregnancy empowerment, self-efficacy for normal birth, and fear of childbirth among primiparous pregnant women. The study will be conducted at the Obstetrics and Gynecology Outpatient Clinic of Silifke State Hospital in Mersin, Turkey, after ethics committee approval. The study population will consist of pregnant women attending the Obstetrics and Gynecology Outpatient Clinic of Silifke State Hospital. Eligible participants will be women aged 18-35 years who are at least primary school graduates, able to communicate in Turkish, between 28 and 34 weeks of gestation, primiparous, carrying a singleton pregnancy, planning a vaginal birth, able to use a smartphone, and have internet access. Women with an indication for planned cesarean section, a history of perineal surgery, an active genital infection or lesion, or cognitive, communication-related, or psychiatric conditions that prevent completion of study forms will be excluded. The planned sample size is 152 pregnant women, with 76 participants in the intervention group and 76 participants in the control group. The sample size was calculated using G\*Power version 3.1.9.7 based on a two-tailed test, a significance level of 0.05, statistical power of 80%, and an assumed medium effect size of Cohen's d = 0.50. The minimum required sample size was calculated as 64 participants per group, and the target sample size was increased to 76 participants per group to account for potential attrition or missing data. Participants in the intervention group will receive structured midwife-led antenatal perineal massage education in addition to routine antenatal care. The educational content will include the importance of pelvic health, preparation for antenatal perineal massage, antenatal perineal massage technique, and maintenance of pelvic health. The intervention is intended to improve women's knowledge and practice of antenatal perineal massage and to support empowerment, confidence regarding normal birth, and reduction of fear related to childbirth. Participants in the control group will receive routine antenatal care provided at the study hospital. Data will be collected using a Participant Information Form, the Antenatal Perineal Massage Knowledge and Preference Form, the Pregnancy Empowerment Scale, the Self-Efficacy Scale for Normal Birth, the Childbirth Attitudes Scale, and the Antenatal Perineal Massage Follow-up Form. The primary outcome will be change in pregnancy empowerment. Secondary outcomes will include change in self-efficacy for normal birth, change in fear of childbirth, antenatal perineal massage knowledge and preferences, and adherence to antenatal perineal massage practice. Baseline data will be collected before the intervention. Post-intervention data will be collected after completion of the antenatal perineal massage education and follow-up period, according to the study protocol. The study is planned to be conducted between May 15, 2026 and December 31, 2026.
Interventions
BEHAVIORALMidwife-Led Antenatal Perineal Massage Education
The intervention is a structured midwife-led antenatal perineal massage education program delivered to primiparous pregnant women in the third trimester. The educational content includes the importance of pelvic health, preparation for antenatal perineal massage, antenatal perineal massage technique, and maintenance of pelvic health. The program is designed to improve knowledge and practice regarding antenatal perineal massage and to support pregnancy empowerment, self-efficacy for normal birth, and reduction of fear of childbirth.
Sponsors
Atlas University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
No masking will be applied because the intervention is an educational intervention and participants and the intervention provider cannot be blinded to group assignment.
Intervention model description
Participants will be assigned to the control and intervention groups using a non-randomized, sequential allocation approach. To minimize contamination between groups and reduce the possibility that control participants may access the educational intervention, data will first be collected from the control group. After completion of control group data collection, the intervention group will receive midwife-led antenatal perineal massage education in addition to routine antenatal care.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 35 Years
Healthy volunteers
Yes
Inclusion criteria
* Women aged 18 to 35 years * At least primary school graduates * Able to communicate in Turkish * Between 28 and 34 weeks of gestation * Primiparous pregnant women * Singleton pregnancy * Planning vaginal birth * Able to use a smartphone * Having internet access * Willing to participate in the study and providing informed consent
Exclusion criteria
* Having an indication for planned cesarean section * History of perineal surgery * Presence of active genital infection or genital lesion * Cognitive, communication-related, or psychiatric condition that may prevent completion of the study forms * Refusal to participate in the study * Withdrawal from the study during the study process * Failure to complete the educational intervention * Missing pre-test or post-test data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pregnancy Empowerment | Baseline and 4 weeks after completion of the education program | Pregnancy empowerment will be assessed using the Pregnancy Empowerment Scale. The outcome will be evaluated by comparing scores between baseline and post-intervention assessment. Higher scores indicate higher pregnancy empowerment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Self-Efficacy for Normal Birth | Baseline and 4 weeks after completion of the education program | Self-efficacy for normal birth will be assessed using the Self-Efficacy Scale for Normal Birth. The scale will be administered at baseline and 4 weeks after completion of the education program. Change in self-efficacy for normal birth will be evaluated by comparing baseline and post-test scores. Higher scores indicate higher perceived self-efficacy for normal birth. |
| Change in Fear of Childbirth | Baseline and 4 weeks after completion of the education program | Fear of childbirth will be assessed using the Childbirth Attitudes Scale. The scale will be administered at baseline and 4 weeks after completion of the education program. Change in fear of childbirth will be evaluated by comparing baseline and post-test scores. |
Countries
Turkey (Türkiye)
Contacts
CONTACTSümeyra Dilek Soydan, Master's degree student
STUDY_CHAIRFiliz Okumuş, Assoc. Prof. Dr.
Atlas University
Outcome results
None listed