Guided Imagery and Positive Birth Experience Sharing on Fear of Childbirth and Self-Efficacy (non)

August 19, 2025 updated by: Sidika Pelit Aksu, Gazi University

The Effect of Guided Imagery and Positive Birth Experience Sharing on Fear of Childbirth and Self-Efficacy: A Randomized Controlled Trial

Abstract This study will be conducted to determine the effect of sharing positive birth experiences and mental imagery on birth self-efficacy and fear of childbirth. The study is a single-center, parallel-group, stratified block (in terms of fear of childbirth level) randomized controlled experimental study. The study sample will consist of a total of 84 participants, with 42 in the intervention group and 42 in the control group. The study is planned to be conducted between July 1, 2025, and July 1, 2026. Inclusion criteria for the study are: WİJMA A scale score average below 85, age over 18, being primiparous, being in the 20th to 26th week of pregnancy, having no complications in the mother or fetus during pregnancy (gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, congenital anomalies, etc.), having no communication problems (mental, auditory, visual, language, etc.), and volunteering to participate in the study. The study data will be collected using a personal information form, the Wijma Childbirth Expectancy/Experience Scale Version A (W-DEQ A), and the Childbirth Self-Efficacy Scale-Short Form (CBSEI-C32). Women will be invited to participate in online training sessions in groups of 3-10 people. Positive birth stories will be shared with the women, and visualization exercises will be demonstrated. Following the training sessions, the follow-up phase of the study will begin, and women will be provided with an audio recording of the visualization guidelines in MP3 format. Women will be asked to perform visualization exercises at least once or twice daily for a minimum of eight weeks. No intervention will be applied to the control group.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Problem Definition Cesarean delivery has significant benefits in high-risk pregnancies, but unnecessary and excessive use of cesarean section has negative consequences on the physical, emotional, and mental health of both mothers and babies. It also places an increasing financial burden on the healthcare system . The increase in the rate of planned cesarean sections before birth cannot be explained by clinical risk factors. This situation can be explained by mothers' preference for planned cesarean sections.

Women's preferences for cesarean sections before birth are influenced by social and cultural factors as well as psychological factors. The most commonly reported psychological factors associated with birth preferences are birth self-efficacy and fear of childbirth. Birth self-efficacy is defined as a person's belief that they can cope with the act of childbirth and the vaginal birth process. Carlson et al. reported that nulliparous women with low self-efficacy in the third trimester of pregnancy experienced higher levels of fear of childbirth compared to women with high self-efficacy. In another study, Lowe found that nulliparous women with lower childbirth self-efficacy were more likely to plan for a cesarean delivery compared to those with higher childbirth self-efficacy. In a study by Schwartz and colleagues, it was determined that self-efficacy is significantly associated with birth preference, independent of parity, and that the intention to have a cesarean delivery increases as self-efficacy decreases. Reducing fear of vaginal birth, thereby increasing positive perceptions of vaginal birth, is important in reducing cesarean preferences.

Having a positive birth experience with vaginal birth or hearing about someone else's positive birth experience can be effective. The sharing of birth stories has increased with the development of new technologies, and women can more easily access others' birth stories through multimedia platforms. Carlsson et al. reported that 97% of nulliparous women had heard birth stories from their mothers and friends. Amyx et al. noted that birth stories are the third most important source of information for nulliparous women, after healthcare professionals and prenatal classes. In a qualitative study of nulliparous women, birth stories were identified as the most useful source of information by 71% of women. Regardless of the type of birth, birth stories have a strong effect on self-efficacy and fear. Therefore, listening to positive birth stories may reduce birth fear in pregnant women.

In recent years, relaxation techniques aimed at reducing fear of childbirth have been increasingly used. One such relaxation technique, mental imagery, is a method for treating stress and anxiety by replacing distressing memories with positive mental images. This involves instructional guidance that triggers sensory experiences, behavioral, and physiological responses. Boryri et al. (2019) found that visualization was effective in reducing fear of childbirth in pregnant women to prevent planned and unnecessary cesarean sections. This study will be conducted to determine the effect of positive birth experience sharing and visualization on birth self-efficacy and fear of childbirth.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
84

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • Turkey
      • Ankara, Turkey
        • Nursing Faculty of Gazi University
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • The WIJMA A scale score average should be below 85, be over 18 years of age, be primiparous, be in the 20-26th week of pregnancy, not have any complications in the mother or fetus during pregnancy (gestational diabetes, hypertension, preeclampsia, intrauterine growth retardation, congenital anomaly, etc.), not have any communication problems (mental, auditory, visual, language, etc.), and be willing to participate in the study.

Exclusion Criteria:

  • Failure to perform post-tests,
  • Participant's wish to withdraw from the study at any stage of the study,
  • Pregnancy turning into a risky pregnancy,
  • Birth occurring before the 37th week of pregnancy,
  • Not performing the visualization exercise for at least three consecutive days.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: experimental group
Pregnant women will be invited to sessions by forming groups of 3-10 people. A face-to-face positive birth experience sharing and mental visualization practice will be done once in the 26-28th weeks of pregnancy at the Gazi University Health Research and Application Center Gynecology and Obstetrics Polyclinic. The positive experience sharing will be done by one of the researchers personally and the pregnant women's questions will be answered after the sharing. The mental visualization techniques prepared by Rossman (2015) to facilitate birth will be used for the mental visualization practice. After the training, the mental visualization instructions will be given to the pregnant women as an audio recording in mp3 format. The pregnant women will be asked to mentally visualize once or twice a day for at least 10 weeks. The mental visualization practice takes approximately 20 minutes. The pregnant women will be reminded to do the practice every day via the Whatsapp® application.
Behavioral: Guided Imagery and Positive Birth Experience Sharing
The positive experience will be shared by one of the researchers and the pregnant women's questions will be answered after the sharing. The mental imagery techniques prepared by Rossman (2015) to facilitate birth will be used for the mental imagery application. After the training, the mental imagery instructions will be given to the pregnant women as an audio recording in mp3 format. The pregnant women will be asked to do the mental imagery once or twice a day for at least 8 weeks. The mental imagery application takes approximately 20 minutes. The pregnant women will be reminded to do the application every day via the Whatsapp® application. The pregnant women will be asked to mark whether they do the application every day or not on the weekly follow-up chart.
No Intervention: control group
No intervention will be applied to the control group. Post-test and follow-up tests will be applied at the same times and with the same scales as the intervention group. Finally, the method of birth will be questioned.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Difference of scores of the Wijma Childbirth Expectation/Experience Scale Version A
Time Frame: 8 weeks
There is a difference between the intervention and control groups in terms of the mean post-test scores of the Wijma Childbirth Expectation/Experience Scale Version A. The minimum score that can be obtained from the scale is 0, and the maximum score is 165. High scores indicate that women have a high fear of childbirth. W-DEQ A score ≤37 indicates mild, 38-65 indicates moderate, 66-84 indicates severe, and ≥85 indicates clinical level fear.
8 weeks
Difference of scores of the Labor Self-Efficacy Scale-Short Form.
Time Frame: 8 weeks
There is a difference between the intervention and control groups in terms of the mean post-test scores of the Labor Self-Efficacy Scale-Short Form.The scale has two sub-dimensions: outcome and adequacy expectations. Each sub-dimension of the scale consists of 16 questions. The lowest score that can be obtained from the scale sub-dimensions is 16, and the highest score is 160. A high score obtained from the sub-dimensions indicates that pregnant women have high adequacy and outcome expectations regarding birth. Responses on the Likert-type scale are scored from 1 to 10. The lowest total score that can be obtained from the scale is 32, and the highest score is 320. High scores obtained from the scale indicate that pregnant women have high levels of self-efficacy in labor.
8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Gazi University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
August 25, 2025

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 25, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 12, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 3, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 3, 2025

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 11, 2025

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 24, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 19, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • E-77082166-604.01-1251133
  • Non (Other Identifier: Non)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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