Effects of Individualized Childbirth Education Program on Anxiety Levels, Mode of Delivery, and Postpartum Adaptation Among Advanced Maternal Age Primiparas.

Background: To investigate the effects of an individualized childbirth education program on childbirth anxiety levels, delivery mode choices, and postpartum adaptation among advanced maternal age primiparas, providing scientific evidence for improving perinatal care quality in this population. Methods: A total of 104 advanced maternal age primiparas who registered at the Tianshui Wulin Subdistrict Community Health Service Center Community Health Service Center's obstetrics clinic (perinatal health care clinic) and delivered between January 2023 and December 2023 were enrolled as research subjects. Using a random number table method, participants were divided into an intervention group (n=55) and a control group (n=49). The control group received routine prenatal examinations and health education, while the intervention group additionally received an individualized childbirth education program, including: (1) customized knowledge instruction based on individual pregnant women's needs and cognitive levels; (2) virtual reality technology-assisted simulation of childbirth scenarios; (3) psychological support and relaxation training; (4) partner-involved joint learning; and (5) establishment of a personalized birth plan. The State-Trait Anxiety Inventory (STAI), Childbirth SelfEfficacy Inventory (CBSEI), delivery mode, and postpartum adaptation (Maternal Postnatal Attachment Scale, MPAS), postpartum depression (Edinburgh Postnatal Depression Scale, EPDS), and subjective well-being (General Well-Being Schedule, GWB) were assessed at 28 weeks, 36 weeks of gestation, and 42 days postpartum, respectively. Results: At baseline (28 weeks gestation), there were no statistically significant differences in STAI and CBSEI scores between the 2 groups (P > .05). Based on change score analysis, the intervention group demonstrated significantly greater anxiety reduction at 36 weeks gestation (change: -5.45 ± 3.21 vs. -0.48 ± 2.87, P < .001, Cohen's d = 1.65) and improved childbirth self-efficacy (change: 25.47 ± 8.92 vs. 4.92 ± 7.34, P < .001, Cohen's d = 2.51) compared to the control group. These large effect sizes indicate clinically meaningful improvements. The rate of vaginal delivery in the intervention group (72.73% vs. 44.90%) was significantly higher than that in the control group, while the cesarean section rate (21.82% vs. 46.94%) was significantly lower than that in the control group (both P < .01). At 42 days postpartum, the MPAS score (83.46 ± 7.25 vs. 75.32 ± 8.14, Cohen's d = 1.06) and GWB score (85.73 ± 8.42 vs. 76.19 ± 9.15, Cohen's d = 1.09) in the intervention group were significantly higher than those in the control group, while the EPDS score (6.27 ± 2.31 vs. 9.45 ± 3.26, Cohen's d = 1.14) was significantly lower than that in the control group (all P < .001). Anxiety reduction was sustained at 42 days postpartum (change: -8.74 ± 4.12 vs. 0.14 ± 3.95, P < .001, Cohen's d = 2.19). The time to first breastfeeding in the intervention group (30.25 ± 15.43 vs. 52.67 ± 18.21 minutes) was significantly earlier than that in the control group (P < .001, Cohen's d = 1.36), the 48-hour milk secretion volume (118.42 ± 35.67 vs. 96.83 ± 32.94 mL) was significantly higher than that in the control group (P = .002, Cohen's d = 0.64), and the exclusive breastfeeding rate at 42 days postpartum (81.82% vs. 61.22%) was higher in the intervention group compared to the control group (P = .018). Conclusion: An individualized childbirth education program for advanced maternal age primiparas can effectively reduce childbirth anxiety levels, improve childbirth self-efficacy, increase the rate of vaginal delivery, and improve postpartum psychological adaptation and breastfeeding outcomes, which has positive significance for enhancing the childbirth experience and postpartum quality of life for advanced maternal age primiparas.