Effects of Prenatal Care Preparation Program on Anxiety in Pregnant Women Undergoing Cesarean Section with Anesthesia

Abstract

Introduction Cesarean section has become an increasingly common method of childbirth, particularly in cases involving pregnancy or delivery complications, or among pregnant women with a history of previous abdominal cesarean section. Although cesarean section is considered a safe procedure when performed under the supervision of a specialized medical team, most pregnant women experience preoperative anxiety. This anxiety often stems from concerns about pain, side effects of anesthesia, surgical risks, and potential impacts on the fetus. Preoperative anxiety is a condition that can affect both the psychological and physical health of pregnant women, potentially influencing postpartum recovery, cooperation with medical care, and the overall childbirth experience. Therefore, developing strategies to alleviate such anxiety is essential. This study aims to develop and examine the effects of a prenatal care preparation program on the anxiety levels of pregnant women undergoing cesarean section with anesthesia. The program provides accurate and sufficient information to help pregnant women adapt and respond effectively to anxiety-inducing situations.

Objectives 1) To compare the anxiety level of pregnant women in the experimental group before and after participating in the Prenatal Care Preparation Program, and 2) To compare the anxiety level after participating in the Prenatal Care Preparation Program between the experimental group and the control group.

Design This study employed a quasi-experimental design with two-group pretest and posttest. The study was guided by Spielberger’s concept of anxiety, which includes the definition, stimuli that trigger anxiety, levels of anxiety, and responses to stress-inducing stimuli. Additionally, Leventhal and Johnson’s self-regulation theory was utilized to develop an anxiety-reduction program. This program involved the construction of cognitive schemas or mental images; complex cognitive structures formed from past experiences. These schemas serve as frameworks that guide human attention, facilitate systematic information storage, and enable the use of existing knowledge to inform goal-directed behavior. Pregnant women respond by seeking information to enhance their understanding of the situation and by evaluating behavioral and emotional coping strategies. This process enables them to make informed decisions about how to confront anxiety-inducing circumstances.

Methodology The participants consisted of 60 pregnant women scheduled for cesarean section at a general hospital in a southern province of Thailand. The participants were selected through purposive sampling based on the following inclusion criteria: aged 18 years or older; no pregnancy complications; hospitalized for at least one day prior to surgery; receiving either general or local anesthesia during the procedure; mentally alert; able to communicate in Thai; no visual or auditory impairments; and voluntarily agreeing to participate in the study. Participants were purposively assigned to two groups: an experimental group (n = 30) and a control group (n = 30). The instruments used in this study included: 1) a prenatal care preparation program for pregnant women undergoing cesarean section with anesthesia. This program focused on information provision, consisting of a teaching plan and a booklet containing information about types of anesthesia and procedures, patient history relevant to anesthesia administration, pre- and postoperative patient self-care instructions, and possible complications during and after anesthesia; 2) an anxiety assessment scale. In the data collection process, the control group received routine care, while the experimental group participated in the prenatal care preparation program through structured information delivery and were provided with the booklet. After surgery, they also received anesthesia for one additional day, were visited in the inpatient unit, and completed the anxiety assessment scale within one day after anesthesia. Data were analyzed by using descriptive statistics, Chi-square test, Independent t-test, Wilcoxon Signed Ranks test, and the Mann-Whitney U test.

Results The control and experimental groups had mean ages of 30.70 years (SD = 0.94) and 30.83 years (SD = 0.77), respectively. Demographic data, as well as pregnancy and childbirth-related information, showed no statistically significant differences between the two groups. The experimental group had a median prenatal anxiety score of 65 (Max = 72, Min = 60) prior to participating in the program, indicating a high level of anxiety. After participating in the program, the median anxiety score was 34 (Max = 37, Min = 29), reflecting a low level of anxiety. After the program, the experimental group exhibited significantly lower anxiety levels compared to before the program (Z = 4.790, p = .001), and significantly lower than those of the control group (U = 6.686, p = .001).

Recommendation The prenatal care preparation program for pregnant women undergoing cesarean section with anesthesia, which emphasizes structured information delivery, has proven effective in reducing anxiety. This program can be adapted for use in routine clinical care. Future studies should be designed using an experimental research approach.