Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

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On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Saraswati Dental College
On Sep 2018

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Calcutta National Medical College & Hospital , Kolkata

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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : QC05 - QC10 Full Version

Stress, Coping, Self-efficacy and Birth Satisfaction among Low-risk Pregnant Women: A Cross-sectional Study

Published: January 1, 2023 | DOI:
KK Ajini, N Rajeev Kumar, JS Ajith Prasad

1. Associate Professor, Department of Obstetrics and Gynaecology, Government Medical College, Thrissur, Kerala, India. 2. Professor and Director, Department of School of Behavioural Sciences, Mahatma Gandhi University, Kottayam, Kerala, India. 3. Associate Professor, Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India.

Correspondence Address :
Dr. JS Ajith Prasad,
Associate Professor, Department of General Surgery, Government Medical College, Thiruvananthapuram-695582, Kerala, India.


Introduction: Pregnant women worry about their physical changes, child delivery and impending parenthood. Wide range of psychological, biological and social factors influence emotional wellbeing during pregnancy which can be described by the extent of birth anxiety, self-efficacy and psychosocial adaptations. The factors like coping and self-efficacy help to overcome the stress and provide better birth satisfaction resulting in good mother and infant bonding.

Aim: To know stress levels among low-risk pregnant women and to assess the influence of coping and self-efficacy of these women on birth satisfaction after delivery.

Materials and Methods: A prospective, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur, Kerala, India, from January 2019 to June 2019. Total 188 pregnant women who reached term and without any known risk factors in the current pregnancy were enrolled. Data was collected using proforma and questionnaires by conducting semi-structured interview to measure pregnancy specific stress, coping, self-efficacy and birth satisfaction. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. Multiple regression analysis was used for analysing the influence of stress, coping and self-efficacy on birth satisfaction.

Results: Study showed that 14.36% of women had high levels of stress. Antenatal women residing at rural areas had high levels of stress than their urban counterparts (p-value=0.004). Employed women had high levels of self-efficacy (p-value=0.038). significant negative correlation was seen between the stress and self-efficacy (r-value=-0.479, p-value<0.00001)

Conclusion: Stress do exist even among low-risk pregnant women. Abilities like coping and self-efficacy improves birth satisfaction in women. Birth satisfaction is an important factor in ensuring positive birth experience and respectful maternity care.


Antenatal clinics, Pregnancy specific stress, Prenatal distress questionnaire, Respectful maternity care

The natural process of pregnancy and childbirth has been considered as a strenuous journey in the life of a woman. Wide range of psychological, biological and social factors influence emotional wellbeing during pregnancy which can be described by the extent of birth anxiety, self-efficacy and psychosocial adaptations (1). But the important ways that women cope with stress during pregnancy is less clear. It is important to know how stress influences the maternity during antenatal period and hence maternal satisfaction after child birth.

There is increasing evidence for the role of biopsychosocial factors in pregnancy and its outcome (2),(3). Pregnancy specific stress is a distinct clinical entity characterised by concerns about physical symptoms, childbirth, health of the baby, mothering and relationship change (4). Its measures are more sensitive than general stress measures in predicting adverse birth outcomes like abnormal foetal development, preterm birth and cognitive development of the child (5). Pregnancy anxiety and stress have been linked to adverse birth outcomes by alterations in the vascular, neuroendocrine and immune systems (6).

Self-efficacy is the strong sense of confidence in one’s own capabilities which protect mothers against stress and promotes more adaptive parenting behaviour (7),(8). Women adopt different coping strategies to overcome the stress, depending up on their self-efficacy, perceived stress, personal attributes and the quality of care received, and these will be reflected in their birth satisfaction. Birth satisfaction is the gratification over what she experienced during childbirth like being treated with respect, having comfort and feeling of being in control (9). Emotional wellbeing of expectant mothers can be described by the extent of pregnancy specific stress, efficiency in coping and self-efficacy (10). Respectful maternity care would improve maternal outcomes in terms of both psychological and physical wellbeing (11).

The mental health is very important in pregnancy. Recent confidential inquiry into maternal deaths of Kerala state also showed an increasing tendency to suicide in young antenatal women. (12) It is important to address the stress issues in pregnancy which influences the maternal behaviour. But unfortunately, the stress aspect is not addressed adequately as the antenatal clinics are too crowded and young women of all social strata have hardly any opportunity to voice their emotional concerns or insecurities and there is no proper screening programme as yet to find out such vulnerable individuals.

Hence, authors decided to explore pregnancy specific stress and coping in the background of self-efficacy and birth satisfaction in antenatal women to fill up the knowledge gap about the behavioural aspects of mothers. The primary aim of this study was to estimate the pregnancy specific stress among low-risk pregnant women. The secondary purpose was to explore coping and self-efficacy in the background of stress and to estimate their birth satisfaction after childbirth. Finally, the study also investigated the correlations between the pregnancy specific stress, coping and self-efficacy and the influence of these variables on birth satisfaction. Null hypothesis was kept as there is no significant influence of stress, coping and self-efficacy of low-risk pregnant women on their birth satisfaction.

Material and Methods

A prospective, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur, Kerala, India, from January 1st of 2019 to June 30th of 2019. Study commenced after approval from the Institutional Ethics Committee of Government Medical College, Thrissur (Letter No: B2-2441/2018/MCTCR dated 29/12/2018). Subjects fulfilling the inclusion criteria were recruited after obtaining a written informed consent. Anonymity and confidentiality were maintained. From the antenatal ward, 188 low risk pregnant women who had completed 37 weeks of gestation participated in the study.

Sample size calculation: The minimum sample size calculated was 176 using the formula, n=z2pq/d2

Where, p=expected proportion in the population which is around 8% (10), q=1-p, d=0.04 (within 4% 0f the true value) Z (1-α/2)=1.96=value of standard normal distribution corresponding to a significance level of α (1.96 for a 2-sided test at the 0.05 level).

Inclusion criteria: Pregnant women of age >18 years and <40years and inpatient antenatal women with gestational age between 37 weeks and 40 weeks were included in the study.

Exclusion criteria: Mothers in extremes of age, with any medical problem (such as hypertensive disorders, diabetes mellitus, anaemia connective tissue disorders, chronic kidney disease and mental illnesses) or with foetal complications (including growth restriction, congenital anomaly and foetal death) were excluded from the study.

From the antenatal ward, 188 low risk pregnant women who had completed 37 weeks of gestation participated in the study.

Study Procedure

Data was collected by semi-structured interview using general data sheet and questionnaires. Study participants were given a brief explanation regarding the purpose of the study. Their doubts were cleared. Certain selected maternal, social, and demographic variables like age, socio-economic status, domicile, educational status, occupation and obstetric variables like order of pregnancy and mode of delivery were collected using a general data sheet. The participants completed three sets of questionnaires to assess pregnancy specific stress, pregnancy specific coping and generalised self-efficacy. Within 48-72 hours of delivery the same participants were approached and data was collected using the questionnaire on birth satisfaction (BSS-R).

Revised Prenatal Distress Questionnaire (Nu PDQ): It was administered to assess pregnancy specific stress (13). It is a 18-question survey using Likert response scale with possible scores ranging from 0 to 34. Participants indicate the extent to which they were feeling bothered, upset or worried about issues in pregnancy. However, Question number 7 on preterm birth) was avoided as study subjects were term (37 weeks completed) antenatal women. Hence 17 item questionnaire was used. It has three subdivisions:

• Prenatal Distress Questionnaire-1 (PDQ1): Dealt with concerns about childbirth, health of the baby and parenting,
• Prenatal Distress Questionnaire-2 (PDQ2): Dealt with physical symptoms, body changes and medical care during antenatal period and
• Prenatal Distress Questionnaire-3 (PDQ3): Dealt with emotions and relationships.

Responses were on a 3-point scale ranging from 0 (not at all) to 2 (very much). Average scores were calculated. Scores above one Standard Deviation (SD) were considered as having high stress levels and scores below 1 SD as low scores.

Revised Prenatal Coping Inventory (Nu PCI): This assesses coping and has good internal consistency (13). Pregnant mothers report how often they used different kinds of coping methods to overcome stress. The Nu PCI consists of 42 items with three reliable subscales, namely, planning-preparation, avoidance and spiritual-positive coping. Scales range from 0 to 4. Questions 21, 29 and 40 were avoided as they pertained to cultural differences which has relevance only in the West. Scores range from 0 to 156. Those persons with scores above 1 SD were considered as having high coping abilities and scores below 1 SD as low scores.

General Self-efficacy scale (GSE): This scale is a self-report measure of self-efficacy (14). The scale is correlated to emotion, stress and anxiety. It contains 10 items. Total score is calculated by finding the sum of all items. Total score range between 10 and 40. Scores above one standard deviation were considered as high levels of self-efficacy and one standard deviation below were considered as low levels of self-efficacy.

Birth Satisfaction Scale Revised (BSS-R): This scale assesses a woman’s birth perceptions and can be easily scored (15). There are 10 items to be assessed with three overarching themes as subscales. These subscales are stress experienced during labour, personal attributes (child birth preparation, ability to cope labour and relationship with baby) and service provision (antenatal care, birth environment and support). Each item is scored on a descending rating from strongly agree (score 4) to strongly disagree (score 0). Items 2, 4, 9 and 8 are reverse scored. Scores range from 0 to 40. Scores above one standard deviation were considered as high levels of birth satisfaction and one standard deviation below were considered as low levels of satisfaction.

Operational Definitions

Pregnancy specific stress: Pregnancy specific stress is a concept built on the knowledge that pregnant women are concerned about the significance of physical symptoms, changes in appearance, changes in interpersonal relationships, labour and delivery, health of foetus and parenting (13).

Coping: Coping is defined as constantly changing cognitive and behavioural efforts aimed at dealing with the demands of specific situations which are appraised as stressful (13).

Self-efficacy: Self efficacy is a dynamic cognitive process that can be described as personal conviction to perform a required behaviour in a given situation successfully (14).

Birth satisfaction: Woman satisfaction with intra-partum care can be considered as gratification over what she received during the childbirth like being treated with respect, feeling in control and receiving minimal injuries (15).

Low-risk pregnancy: Antenatal mothers devoid of medical complications and no foetal risks like foetal growth restriction, congenital anomalies, etc, operating in current pregnancy.

Respectful maternity care: Delivery of appropriate and respectful care to pregnant women (11).

Statistical Analysis

Categorical variables were expressed as numbers and percentages, while continuous variables were expressed as mean±SD. Computation of t-value to test the significance of difference between the means of two groups of data, One way analysis of variance to test the significance of difference between the means of more than two groups of data. Karl Pearson’s product moment coefficient of correlations was used for comparing the relationship between stress, coping and self-efficacy. Multiple regression analysis was used for analysing the influence of stress, coping and self-efficacy on birth satisfaction. All statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 16.0 and a p-value <0.05 was considered as significant.


A total of 188 subjects were recruited for the study of which primigravidas constituted 44%. Mean age of the study population was 27.28±4.21 years. All were living with spouses, majority had pregnancy which was planned and none of them reported any domestic violence. Majority had achieved education levels beyond high school but were unemployed (79.78%). (Table/Fig 1) shows the variations of parameters according to their age, education, employment, domicile, economic status, religion, order of pregnancy and mode of delivery.

Low-risk pregnant women residing at rural areas had more levels of stress than urban women (p-value=0.004). Thus, there was significant difference in stress levels of low-risk pregnant women with respect to domicile. Urban women had high levels of self-efficacy than rural women and the difference was significant as shown in the (Table/Fig 2) (p-value=0.024). Employed women had higher levels of self-efficacy than the unemployed women and the difference was significant (p-value=0.038). Coping ability and birth satisfaction were not affected by these socio-demographic and obstetric variables.

(Table/Fig 2) shows the distribution of scores obtained for stress, coping, self-efficacy and birth satisfaction. Pregnancy specific stress levels were higher in 14.36% of the women indicating pregnancy specific stress existed even among low-risk pregnant mothers. About 13.83%, 13.57% of women respectively had low scores for pregnancy specific coping and general self-efficacy scores. Significant positive correlation was found between stress and coping in pregnant women (r-value=0.380, p-value <0.00001). Whereas, significant negative correlation was found between stress and self-efficacy (r-value=-0.479, p-value <0.00001) (Table/Fig 3).

Figure showing distribution of scores is shown below.

(Table/Fig 4) shows stepwise regression model for analysing the influence of pregnancy specific stress, coping, self-efficacy on birth satisfaction of mothers. All the three models of analysis were significant. However, the first model was the most appropriate model which predicted birth satisfaction as the F value for that model was 51.00 which was highly significant. Self-efficacy scores could predict the birth satisfaction better. The results revealed high levels self-efficay scores predicted the birth satisfaction better than others.


The results revealed the existence of stress even among low-risk pregnant women. In present study pregnancy specific stress was not influenced by any of the socio-demographic and obstetric variables except the domicile of women. The women residing in rural areas had more levels of stress than urban women. Schoch-Ruppen J et al., in their study revealed that stress levels were higher among study participants who were younger, nulliparous, lacked college education, unmarried or having an unplanned pregnancy compared to their counter parts (16). Nu PDQ scores were higher among women experiencing stress from interpersonal relationships, including those undergoing separation or divorce (17). Studies administering Nu PDQ from Iran also report high levels of stress among antenatal women (6),(18). Similar results came from USA and UK also (19),(20). But lower levels of stress were reported in a few studies from UK giving the impression that the stress levels vary in different parts of the world (21),(22).

Mothers participated showed good amount of pregnancy specific coping skills. Hamilton JG and Lobel M concluded that all of the coping strategies were correlated with greater distress (23). Similar results were noted by Koletzko SH et al., (24). Lack of coping skills were associated with many adverse mental outcomes including lower general psychological wellbeing, increased distress, more anxiety and greater child abuse potential (25).

Low-risk pregnant women from urban location showed more self-efficacy than their rural counterparts. This may be due to increased awareness and exposure the urban women get during their life. Rural women seem more dependent and get fewer chances to do things on their own. Employees showed more self-efficacy than workers, self-employed and unemployed women. This may be related to the independence the employees enjoy when compared to others and also to better life orientation. Findings showed that self-efficacy was negatively associated with stress. Ginja S et al., have reported positive corelation between self-efficacy, mental well-being and social support (26). Self-efficacy of women empower them to cope with stressful events. Mothers with high self-efficacy experience a lower level of stress and have high social relationship and support and experience high levels of birth satisfaction (27). Antenatal self-efficacy was strongly associated with coping, which ultimately led to greater levels of birth satisfaction. Salomonsson B et al., reported that high levels of perceived self-efficacy contribute to a sustained behaviour that women consider useful to coping with labour (28). A substantial positive change with regards to self-efficacy helps mothers to keep control during labour and also adds to their confidence. Consistent with Bandura’s Self-efficacy theory, increasing individual self-efficacy promotes individual’s belief in her own capacity to deal with stress (7).

There were no significant differences in the birth satisfaction of women with respect to obstetric or socio-demographic variables. The impact of the mode of delivery remains controversial. Historically, vaginal delivery has been represented as the mode that has the best chance of being positively experienced and some studies suggest a positive experience with spontaneous vaginal delivery because it is associated with a high perceived control level compared to instrumental vaginal delivery or caesarean section, and a higher feeling of accomplishment (29),(30). But a later study reported exactly opposite results (31). These conflicting results highlight the complexity when studying the delivery experience. In the light of increasing awareness on the risks of caesarean sections and the supplementary costs involved, the impact of mode of delivery on the construction of birth satisfaction is important. However, present study results showed no significant difference in birth satisfaction according to the mode of delivery.

In the present study, regression analysis showed that the high levels of self-efficacy scores predicted the birth satisfaction. Sinclair M and O’Boyle C reported that high levels of perceived self-efficacy contribute to increased motivation to sustain a behaviour that women consider useful for coping with labour (32). Substantial positive changes during pregnancy with regards to self-efficacy for facing labour and childbirth help mothers to keep control during labour. This improves the quality of preparation for labour and delivery and also adds the confidence of the mother (33). Findings emphasized that coping makes them more efficient in facing the challenging role of motherhood. Self-efficacy is a psychological factor that can be modified through various efficacy enhancing interventions and can be enhanced through structured maternal education as reported by Maimberg RD et al., and Brixva CS et al., (34),(35). Self-efficacy is an important construct which is related to effective coping. Women’s satisfaction with childbirth is also an important measure of quality of maternal health care. Currently it is generally agreed that satisfaction refers to a level of correspondence between health services and patient need, desire and expectation. Respectful maternity care is very important in creating a positive birth experience for women. Evaluating birth satisfaction allows positive changes in the quality of health care delivery and identifies problem areas (36). Self-efficacy and coping are two important determinants of birth-satisfaction. Birth satisfaction ensures maternal well-being and influences future obstetric career of women. Hence focus on these behavioural aspects of mothers will help find vulnerable individuals so that special attention can be provided to them.

Present study supported the need for improving self-efficacy and coping behaviours during antenatal period to improve the birth satisfaction and to alleviate stress. Recently the government has launched a project ‘AMMA MANASU’ in association with the National Mental Health Programme (NMHP) in August 2019 which is intended to address psychiatric illnesses like depression in expectant and postpartum mothers at the earliest (37). Screening for behavioural skills among antenatal mothers will help to find out the vulnerable individuals.


Cross-sectional nature of the study is a limitation; more beneficial results would have emerged if it was longitudinal in nature. The main limitation was time. It would have been more beneficial if subjects were followed-up for the entire puerperium and problems like postpartum blues were also assessed.


Present study was conducted to assess the pregnancy specific stress, coping skills, and self-efficacy and to find out the influence of these variables on birth satisfaction. Results revealed the existence of stress even among the low-risk mothers and rural women had more levels of stress. Self-efficacy beliefs were strongly correlated with the use of coping behaviours. Urban and employed women had significant levels of self-efficacy which indicate the need for ensuring the accessibility and affordability of pregnancy care. Birth satisfaction is significantly influenced by self-efficacy. Screening for behavioural skills will help the overcrowded antenatal clinics to find out the vulnerable individuals .If these issues are not addressed in right time, the care provided to the mother is incomplete and there won’t be a desirable outcome of pregnancy. Future research would benefit from longitudinal studies through pregnancy and into postnatal period to assess behaviour in post-partum period. Such studies could explore the different paths to pregnancy specific stress and other characteristics of mothers.


Authors acknowledge the contributions of Mr Ambady KG, Research Scholar at Mahatma Gandhi University for the help provided as statistician. Authors also acknowledge Journal of Clinical and Diagnostic Research for rephrasing. This research received no grant from any funding agency. There is no conflict of interest involved in this research and its publication.


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DOI and Others

DOI: 10.7860/JCDR/2023/59828.17413

Date of Submission: Aug 24, 2022
Date of Peer Review: Oct 28, 2022
Date of Acceptance: Dec 22, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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