Abstract
At 58.1%, the cesarean birth rate in the Dominican Republic (DR) is the highest in the world (1). The World Health Organization cites the overuse of elective cesareans as a global health priority, but states reduction efforts should utilize educational interventions that incorporate local determinants of health (2,3). This descriptive, cross-sectional, convergent mixed methods study examined childbirth self-efficacy, demographics, and beliefs about labor and birth in expectant and newly postpartum parents from low resourced communities in the Dominican Republic. A demographic survey, researcher-designed items grounded in the theory of planned behavior, and the 62-item Spanish version (4) of the 4 subscale Childbirth Self-Efficacy Inventory (CSEI) was administered to 130 Dominican and Haitian women living in the DR. Participants were recruited in five communities throughout Puerta Plata, DR by convenience and snowball sampling for the quantitative arm, and 33 participated in interviews. Multivariable linear regression modeling and thematic analysis were used to analyze data. Maternal age and education were not significantly related to any of the CSEI subscales (all p > 0.100) for Dominican women (n = 73). The average childbirth self-efficacy in the birth help subscale was lower for those with primary education relative to any secondary school (2 df p = 0.051) for Haitian women (n = 57). Also, significant mean comparisons revealed Haitian women in the third trimester had significantly lower scores than those in the first trimester (p = 0.0288) and postpartum (p = 0.0283) on the birth confidence subscale. Although not significant on any CSEI subscales, grandmothers or mothers were overwhelmingly selected as the primary source of childbirth education for Dominican (53%) and Haitian (56%) women while healthcare providers were only listed as 22% and 14% respectively. Due to a lack of significant variance of CSEI scores across ages and education levels, one childbirth curriculum can be developed that is accessible and relevant for a broad audience of Dominican women. Conversely, for Haitian women living in the DR, childbirth education modules would be maximally effective if they are targeted to increase confidence for those with primary education and in the third trimester. Themes of familial support and wisdom, physician influence, and cultural normalization supported survey data.
Notes
Financial support by the Elon University Faculty Research & Development Hultquist Award (2024).
Program support in the Dominican Republic graciously provided by Second Chance Global, Inc.
References:
1.Betran, A. P., Ye, J., Moller, A. B., Souza, J. P., & Zhang, J. (2021). Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health, 6(6), e005671. https://doi.org/10.1136/bmjgh-2021-005671
2. Angolile, C. M., Max, B. L., Mushemba, J., & Mashauri, H. L. (2023). Global increased cesarean section rates and public health implications: A call to action. Health Science Reports, 6(5), e1274. https://doi.org/10.1002/hsr2.1274
3. Opiyo, N., Kingdon, C., Oladapo, O. T., Souza, J. P., Vogel, J. P., Bonet, M., Bucagu, M., Portela, A., McConville, F., Downe, S., Gülmezoglu, A. M., & Betrán, A. P. (2020). Non-clinical interventions to reduce unnecessary caesarean sections: WHO recommendations. Bulletin of the World Health Organization, 98(1), 66–68. https://doi.org/10.2471/BLT.19.236729
4. Cunqueiro, M. J., Comeche, M. I., & Docampo, D. (2009). Childbirth Self-Efficacy Inventory: psychometric testing of the Spanish version. Journal of Advanced Nursing, 65(12), 2710–2718. https://doi.org/10.1111/j.1365-2648.2009.05161.x
Sigma Membership
Gamma Zeta
Type
Poster
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Mixed/Multi Method Research
Keywords:
Sustainable Development Goals, Health Equity or Social Determinants of Health, Public and Community Health, Self-Efficacy, Childbirth & Psychology, Childbirth, Dominican Republic
Recommended Citation
Hubbard, Lori; McCoy, Thomas P.; Aquino, Katherine; Charles, Franceska; Ricker, Julia; and Carlson, Gabrielle, "Childbirth Self-Efficacy and Factors Influencing Labor and Birth in the Dominican Republic" (2026). International Nursing Research Congress (INRC). 92.
https://www.sigmarepository.org/inrc/2026/posters_2026/92
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-04
Childbirth Self-Efficacy and Factors Influencing Labor and Birth in the Dominican Republic
Toronto, Ontario, Canada
At 58.1%, the cesarean birth rate in the Dominican Republic (DR) is the highest in the world (1). The World Health Organization cites the overuse of elective cesareans as a global health priority, but states reduction efforts should utilize educational interventions that incorporate local determinants of health (2,3). This descriptive, cross-sectional, convergent mixed methods study examined childbirth self-efficacy, demographics, and beliefs about labor and birth in expectant and newly postpartum parents from low resourced communities in the Dominican Republic. A demographic survey, researcher-designed items grounded in the theory of planned behavior, and the 62-item Spanish version (4) of the 4 subscale Childbirth Self-Efficacy Inventory (CSEI) was administered to 130 Dominican and Haitian women living in the DR. Participants were recruited in five communities throughout Puerta Plata, DR by convenience and snowball sampling for the quantitative arm, and 33 participated in interviews. Multivariable linear regression modeling and thematic analysis were used to analyze data. Maternal age and education were not significantly related to any of the CSEI subscales (all p > 0.100) for Dominican women (n = 73). The average childbirth self-efficacy in the birth help subscale was lower for those with primary education relative to any secondary school (2 df p = 0.051) for Haitian women (n = 57). Also, significant mean comparisons revealed Haitian women in the third trimester had significantly lower scores than those in the first trimester (p = 0.0288) and postpartum (p = 0.0283) on the birth confidence subscale. Although not significant on any CSEI subscales, grandmothers or mothers were overwhelmingly selected as the primary source of childbirth education for Dominican (53%) and Haitian (56%) women while healthcare providers were only listed as 22% and 14% respectively. Due to a lack of significant variance of CSEI scores across ages and education levels, one childbirth curriculum can be developed that is accessible and relevant for a broad audience of Dominican women. Conversely, for Haitian women living in the DR, childbirth education modules would be maximally effective if they are targeted to increase confidence for those with primary education and in the third trimester. Themes of familial support and wisdom, physician influence, and cultural normalization supported survey data.
Description
This study examined childbirth self-efficacy (CSE) and beliefs about birth in expectant and postpartum parents from low resourced communities in the DR where the cesarean rate is 58.1%. Mothers/grandmothers as primary supporters and sources of childbirth knowledge in Dominican and Haitian women and lower CSE in third trimester Haitian women with primary education will guide the development of culturally sensitive education to foster increased rates of physiologic birth and maternal empowerment.