Examination of the Factors Influencing Women's Birth Beliefs According to the Biopsychosocial Model

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Understanding these pathways is critical for developing effective interventions to support women's decision-making and reduce unnecessary caesarean sections. This study was conducted to examine women's birth beliefs through the biopsychosocial model using structural equation modelling, and to compare the biological, psychological, and social determinants between nulliparous and parous women. Methods Cross-sectional study of 438 married women (18–45 years) in Ankara, Turkey (February–June 2025). Participants completed assessments of biological factors, seven psychological scales, two social support measures, and a birth preference item. Structural equation modelling identified predictive pathways separately for nulliparous (53.7%) and parous (46.3%) groups. Results Among nulliparous women, 15 predictors significantly influenced birth beliefs: seven biological (privacy belief, miscarriage, negative pregnancy events, parental birth experience, dysmenorrhoea, menstrual regularity, age), six psychological (pain catastrophizing, self-efficacy, fear of birth, health anxiety, optimism, maternal attitudes), and two social (perceived social support, partner support). Among parous women, only four factors were significant: privacy provision, adequate attention, health anxiety, and perceived social support. Conclusions Birth beliefs are genuinely multidimensional, shaped by interacting biopsychosocial factors. Nulliparous women are influenced by substantially more factors than parous women, suggesting that direct birth experience functions as a powerful filter for future beliefs. Comprehensive, individualized antenatal care addressing all three domains particularly for first time mothers may strengthen positive birth beliefs and reduce unnecessary caesarean sections. Biopsychosocial Model Birth Birth Belief Birth Preference Women Figures Figure 1 Figure 2 Figure 3 Introduction Women's birth experience is not solely physiological but a multidimensional life event shaped by emotional, cognitive, and social dynamics [¹]. Birth preferences are influenced not only by physiological needs but also by psychological tendencies and social relationships [²]. The global rise in caesarean rates currently 21% worldwide with projections reaching 28.5% by 2030, and exceeding 57% in Turkey (the highest rate globally) underscores the need for a systematic, holistic evaluation of determinants of women's birth-related decisions [³]. The biopsychosocial model, first proposed by Engel (1977), posits that health-related behaviours should be understood through the dynamic interaction of biological, psychological, and social contexts [⁴]. This framework has proven valuable in understanding complex health decisions, yet its application to birth preferences remains limited. Accordingly, women's birth preferences are shaped by biological factors such as age, pregnancy history, prior birth mode, and health status, alongside partner attitudes for example, perceptions of caesarean safety [⁵]. Psychological variables are equally critical: fear of birth has been linked to loneliness and indecision [6], concern about pain increases caesarean preference [3], whereas self-efficacy promotes vaginal birth [²,³]. Studies indicate that approximately 6–15% of nulliparous women report high fear of childbirth, which significantly influences mode of delivery preferences. Perceived control, traumatic memories, and psychological support further influence decision-making [¹,⁷]. Sociological factors also play a decisive role, embedding birth preferences within cultural norms and social support networks. As Kosan et al. (2019) noted, women often follow the guidance of relatives and friends in the absence of adequate knowledge [⁸]. Cross-national studies confirm that cultural values significantly shape caesarean versus vaginal birth choices [⁹,¹⁰]. Despite this evidence, few studies adopt a truly holistic biopsychosocial lens that systematically integrates all three domains, and systematic comparisons between nulliparous women's prospective decisions and parous women's experience-based preferences remain scarce. Understanding these integrated pathways and how prior experience modifies them is critical for developing effective, targeted antenatal interventions and reducing unnecessary caesarean sections. Therefore, this study aimed to examine women's birth beliefs through the biopsychosocial model, using structural equation modelling to identify the biological, psychological, and social determinants and their interrelations. By comparing nulliparous and parous women, the study further sought to clarify how previous birth experience modifies these associations. Research question How do biological, psychological, and social factors collectively influence women's birth beliefs, and does previous birth experience modify the pattern and magnitude of these multidimensional influences? Methods Study Design Cross-sectional descriptive-analytical study, reported in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Data were collected face-to-face (Feb–June 2025) using convenience sampling.The application of questionnaires took approximately 30–45 minutes. P opulation The study population consisted of married women aged 18–45 years residing in Ankara. Eligibility criteria included being literate in Turkish, cognitively able to complete the questionnaire, and either nulliparous or having given birth within the last 10 years. Exclusion criteria were: being unmarried, 45 years of age, pregnancy at the time of data collection, life-threatening obstetric complications, or language difficulties. A total of 485 women were screened; 47 were excluded (most commonly due to pregnancy, 3.1%). The final sample comprised 438 women, yielding a 90.3% participation rate (Fig. 1 ). Data collection The tool comprised four parts: Demographic Form This form covers socioeconomic variables such as age, educational status, marital status, income level, partner's education, and employment status. Biological form This form includes biological variables such as pregnancy history, number of births, mode of birth, previous birth experiences, medical interventions, and health problems. Psychological Scales: Pain Catastrophising Scale (PCS) This scale was developed by Sullivan, Bishop, and Pivik (1995) [ 11 ] the Turkish validity and reliability study was conducted by Uğurlu et al. (2017). It has a five-point Likert structure and consists of 13 items in total. The items in the scale are divided into rumination, magnification, and helplessness sub-dimensions. The total score obtained from the scale ranges between 0 and 52, with higher scores indicating a higher tendency to catastrophise pain. The Cronbach alpha coefficient was reported as 0.92 in the Turkish form of the scale [ 12 ]. In this study, it was determined as 0.80. General Self-Efficacy Scale : This scale was developed by Sherer et al. (1982) [ 13 ] and adapted to Turkish by Yıldırım and İlhan (2010). The scale, which is a five-point Likert type, consists of 17 items and has three sub-dimensions: initiation, persistence, and effort persistence. The score that can be obtained from the scale ranges between 17 and 85, with higher scores indicating that the individual's self-efficacy level is high. The Cronbach alpha coefficient is 0.80 [ 14 ]. In this study, it was determined as 0.51. Childhood Trauma Questionnaire (CTQ) : This scale was developed by Bernstein et al. (1994) [ 15 ] and adapted to Turkish by Şar et al. (2012). The scale, which is a five-point Likert type, consists of 28 items. It has five sub-dimensions: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. The total score obtained from the scale ranges between 25 and 125. The Cronbach alpha value is 0.90 [ 16 ]. In this study, it was determined as 0.119. Prenatal Fear of Birth Scale This scale was developed by Stoll et al. (2016) [ 17 ] and adapted to Turkish by Uçar and Taşhan (2017). The scale, which is a six-point Likert type, consists of 10 items and covers dimensions such as birth pain, loss of control, inability to cope with birth, fear of complications, and fear of physical harm. The score that can be obtained from the scale ranges between 10 and 60, with higher scores indicating a higher level of fear. The Cronbach alpha coefficient is 0.86 [ 18 ] In this study, it was determined as 0.85. Health Anxiety Inventory (HAI) This scale was developed by Salkovskis et al. (2002) [ 19 ] and adapted to Turkish by Aydemir et al. (2013). It consists of 18 items in total and has a four-point Likert structure. The first 14 items evaluate health concerns related to the body, whilst the last 4 items evaluate anxiety about the possible negative consequences of illness. The scores obtained from the scale range between 0 and 54, with higher scores indicating higher levels of health anxiety. The Cronbach alpha value of the scale is 0.88 [ 20 ]. In this study, it was determined as 0.65. Optimism and Pessimism Scale - Adult Form This scale was developed by Çalışkan and Karademir (2023). The scale, which consists of twenty items, has a five-point Likert structure. The total score obtained from the scale indicates the individual's optimism or pessimism orientation. High scores reflect optimism, whilst low scores reflect pessimism. The Cronbach alpha coefficient is 0.87 [ 21 ]. In this study, it was determined as 0.81. Attitudes Toward Motherhood Scale : This scale was developed by Sockol et al. (2014) [ 22 ] and adapted to Turkish by Şenyaşar Meterelliyoz et al. (2023). The 12-item structure consists of three sub-dimensions: others' judgements, maternal responsibility, and idealisation of the maternal role. The scores obtained from the six-point Likert scale reflect the cognitive dimension of the individual's attitudes towards motherhood. As the total score increases, the level of cognitive distortion also increases. The Cronbach alpha value of the scale is 0.81[ 23 ]. In this study, it was determined as 0.80. Social Scales Social variables were evaluated with the Multidimensional Perceived Social Support and Partner Support Scales. Multidimensional Perceived Social Support Scale (MSPSS) : This scale was developed by Zimet et al. (1988) [ 24 ] and adapted to Turkish by Eker et al. (2001). The scale, which is a seven-point Likert type, consists of 12 items and comprises three sub-dimensions: family, friends, and significant others. The total score obtained from the scale reflects the level of social support. The Cronbach alpha value is 0.89 [ 25 ]. In this study, it was determined as 0.84. Partner Support Scale : This scale was developed by Yıldırım (2004). The scale, which is a three-point Likert type, consists of 27 items and includes four sub-dimensions: emotional support, information and material assistance, appreciation support, and social interest support. High scores obtained from the scale indicate high perceived support from the partner. The Cronbach alpha coefficient was reported as 0.95 [ 26 ]. In this study, it was determined as 0.72. Birth Relief Variable Defined as positive beliefs toward vaginal birth, based on 5-point preference item (1 = definitely caesarean, 5 = definitely vaginal). Pilot and Ethics Content validity was ensured via three experts. Pilot testing was conducted with 40 women (~ 10% of the sample). This study received ethics approval from (Ankara Medipol University Ethics Committee, No: 2025/24) and all participants provided written informed consent Statistical analysis Data were analysed using SPSS 22.0 and AMOS 24.0. Descriptive statistics and Cronbach’s α assessed sample and scale properties. Women were classified as parous or nulliparous, and factors influencing birth beliefs were examined using structural equation modelling (SEM) within the biopsychosocial framework. Scale scores were treated as continuous variables. Model fit was evaluated with χ²/df ( 0.90), GFI (> 0.90), and RMSEA (< 0.08). Structural paths were reported with β, SE, CR, and p-values. Results Data from 438 women were analysed; 46.3% were parous and 53.7% nulliparous. While descriptive statistics were presented for the full sample, SEM analyses were conducted separately for parous and nulliparous groups. Participants had a mean age of 32.7 ± 6.5 years, partners 35.2 ± 7.0; mean marriage age was 24.5 with an average duration of 8.2 years. Half were university graduates, 54.3% employed, and 82.9% preferred vaginal birth for future delivery. Scale distributions Descriptive analyses indicated that most scales approximated normality, although CTQ, HAI, and MSPSS showed deviations. Internal consistency was acceptable overall, except for CTQ and GSES, which demonstrated lower reliability (Table 1 ) Table 1 Mean scores of measurement tools and evaluation of normal distributions Measurement Tools Min. Max. X̄ SD Normal Distribution Skewness Kurtosis PCS 4.00 67.00 32.86 8.47 − .743 1.033 GSES 26.00 89.00 48.89 6.19 .260 5.018 CTQ 31.00 85.00 50.56 6.05 1.755 7.592 PFBS 10.00 60.00 40.27 6.77 − .777 2.149 HAI 1.00 48.00 14.46 6.55 1.444 4.205 OPS 42.00 78.00 58.46 4.57 − .012 .769 ATMS 0.00 56.00 31.55 6.84 -1.021 4.003 LS 1.0 10.00 5.70 2.81 − .240 − .626 MSPSS 13.00 84.00 77.82 7.73 -4.112 22.555 PSS 27.00 105.00 70.96 7.99 − .474 7.896 Min: minimum; Max: maximum; X̄: mean; SD: standard deviation Biopsychosocial effects Nulliparous women SEM results indicated significant biopsychosocial determinants of Birth Relief among nulliparous women. Biological factors Positive predictors included privacy assurance (β = .16), parental positive birth experience (β = .12), and dysmenorrhoea (β = .15). Conversely, miscarriage (β=-.17), adverse pregnancy events (β=-.22), menstrual irregularity (β=-.28), and higher age (β=-.13) exerted negative effects. Psychological factors Greater self-efficacy (β = .21), optimism (β = .22), and health anxiety (β = .09) were positive predictors, whereas pain catastrophising (β=-.13), fear of birth (β=-.15), and negative maternal attitudes (β=-.29) were negative. Childhood trauma was non-significant. Social factors Both perceived social support (β=-.10) and partner support (β=-.27) were negatively associated with Birth Relief. Model fit indices confirmed acceptable fit (Fig. 2 ; Table 2 ). The strongest negative predictors were negative maternal attitudes, menstrual irregularity, and partner support. Table 2 Effects of Biopsychosocial Factors on Birth Preference in Nulliparous Women (SEM Results) Latent Construct Variable β β₁ SE t p Biological dimension Birth Relief <-- Poor treatment expectation 0.004 0.004 0.044 0.09 0.928 Birth Relief <-- Belief that privacy will be ensured 0.163 0.208 0.054 3.827 < 0.001 Birth Relief <-- Abortion experience 0.021 0.061 0.122 0.499 0.618 Birth Relief <-- Miscarriage experience -0.165 -0.328 0.085 -3.852 < 0.001 Birth Relief <-- Experiencing negative events during pregnancy -0.221 -1.24 0.24 -5.168 < 0.001 Birth Relief <-- Parental birth experience 0.119 0.154 0.055 2.789 0.005 Birth Relief <-- Dysmenorrhoea 0.151 0.189 0.054 3.532 < 0.001 Birth Relief <-- Menstrual regularity -0.281 -0.33 0.05 -6.568 < 0.001 Birth Relief <-- Age -0.13 -0.016 0.005 -3.055 0.002 Birth Relief <-- Trust in healthcare personnel -0.07 -0.075 0.046 -1.636 0.102 Psychological dimension Birth Relief <-- PCS Total -0.128 -0.023 0.008 -3.002 0.003 Birth Relief <-- GSES Total 0.211 0.028 0.006 4.929 < 0.001 Birth Relief <-- CTQ Total 0.014 0.002 0.006 0.323 0.747 Birth Relief <-- PFBS Total -0.152 -0.023 0.007 -3.562 < 0.001 Birth Relief <-- HAI Total 0.092 0.01 0.005 2.16 0.031 Birth Relief <-- OPS Total 0.223 0.029 0.005 5.231 < 0.001 Birth Relief <-- ATMS Total -0.286 -0.038 0.006 -6.695 < 0.001 Social dimension Birth Relief <-- Perceived social support -0.102 -0.015 0.006 -2.393 0.017 Birth Relief <--- Partner support -0.27 -0.023 0.004 -6.324 < 0.001 SE: Standard error; β: standardised path coefficients; β₁: unstandardised path coefficients; t: t-statistic; p: significance level. Parous women SEM analysis among parous women identified fewer significant predictors of Birth Relief. Biological factors Privacy provision (β = .17, p = .007) and receiving adequate attention (β = .17, p = .007) were positively associated with Birth Relief. Psychological factors Health anxiety emerged as a negative predictor (β=-.23, p .05). Model fit indices confirmed acceptable model adequacy (Fig. 3 ; Table 3 ). Table 3 Effects of Biopsychosocial Factors on Birth Preference in Parous Women (SEM Results) Latent Construct Variable β β₁ SE t p Biological dimension Birth Relief <-- Regular menstruation 0.09 0.042 0.029 1.454 0.146 Birth Relief <-- Dysmenorrhoea -0.101 -0.045 0.027 -1.64 0.101 Birth Relief <-- Negative experience during pregnancy -0.025 -0.011 0.027 -0.4 0.689 Birth Relief <-- Physical space inadequacy 0.018 0.01 0.033 0.296 0.767 Birth Relief <-- Poor treatment experience -0.109 -0.078 0.044 -1.773 0.076 Birth Relief <-- Postpartum health problems 0.043 0.037 0.053 0.701 0.483 Birth Relief <-- Episiotomy experience -0.032 -0.014 0.027 -0.516 0.606 Birth Relief <-- Privacy provision 0.168 0.3 0.111 2.713 0.007 Birth Relief <-- Receiving adequate attention 0.166 0.196 0.073 2.686 0.007 Birth Relief <-- Experiencing chronic illness during pregnancy 0.087 0.11 0.079 1.403 0.161 Birth Relief <-- Mode of last birth 0.078 0.038 0.03 1.259 0.208 Birth Relief <-- Age 0.098 0.003 0.002 1.586 0.113 Psychological dimension Birth Relief <-- PCS Total -0.045 -0.001 0.002 -0.731 0.465 Birth Relief <-- GSES Total 0.026 0.001 0.002 0.427 0.67 Birth Relief <-- CTQ Total 0.083 0.002 0.002 1.35 0.177 Birth Relief <-- PFBS Total 0.082 0.002 0.002 1.334 0.182 Birth Relief <-- HAI Total -0.23 -0.006 0.002 -3.722 < 0.001 Birth Relief <-- OPS Total -0.005 0 0.003 -0.077 0.938 Birth Relief <-- ATMS Total 0.05 0.001 0.001 0.818 0.414 Birth Relief <-- Loneliness Scale -0.041 -0.003 0.004 -0.671 0.502 Social dimension Birth Relief <-- Perceived social support -0.153 -0.003 0.001 -2.479 0.013 Birth Relief <-- Partner support -0.071 -0.002 0.001 -1.143 0.253 SE: Standard error; β: standardised path coefficients; β₁: unstandardised path coefficients; t: t-statistic; p: significance level. Discussion This study, the first to address birth preferences within a biopsychosocial framework. Biological factors Among nulliparous women, predictors of birth beliefs included privacy, pregnancy loss, adverse antenatal events, parental birth experiences, dysmenorrhoea, menstrual regularity, and age; among parous women, privacy and feeling adequately attended to were influential. Privacy was a positive determinant in both groups, consistent with studies showing that safeguarding autonomy enhances confidence but may also lead some women to prefer caesarean birth [ 3 , 9 , 27 ]. Pregnancy loss was linked to more negative beliefs [ 28;29,30 ], as were adverse antenatal experiences [ 30 , 31 ]. Positive parental birth narratives predicted favourable beliefs, reflecting cultural transmission [ 6 , 9 , 32 ]. Dysmenorrhoea and irregular cycles correlated with negative beliefs [ 33 – 35 ]. Increasing age was associated with perceiving birth as risky, supporting evidence of higher caesarean preference with older maternal age [ 5 , 8 , 35 ]. Among parous women, respectful and attentive care predicted more positive beliefs, in line with prior work emphasising professional and emotional support [ 1 , 31 ]. Collectively, these findings highlight the influence of both individual (e.g.,miscarriage, menstrual health, adverse experiences) and cultural/environmental (e.g.,parental narratives, age) factors on birth beliefs. Psychological factors Among nulliparous women, higher pain catastrophising was linked to less positive birth beliefs, consistent with findings that difficulty coping with pain negatively shapes expectations [ 36 – 38 ]. Health anxiety showed a complex pattern: while higher anxiety correlated with more positive beliefs among nulliparous women, possibly reflecting proactive engagement, it was associated with reduced confidence in vaginal birth among parous women, aligning with evidence that medicalised anxiety influences caesarean preference [ 3, 1 0,41 ]. Optimism was positively related to birth beliefs, whereas pessimistic experiences predicted more negative preferences, regardless of mode of birth [ 1 ]. Negative attitudes toward motherhood among nulliparous women also predicted less favourable beliefs about vaginal birth, suggesting that antenatal education addressing maternal role perceptions may support healthier preferences. Sociological factors Across both groups, higher perceived social support was paradoxically linked to more negative birth beliefs, though prior studies reported positive associations, suggesting that effects may depend on the type and quality of support [ 39, 40 ]. Among nulliparous women, reduced partner support predicted more negative beliefs, consistent with findings that strong partner support fosters confidence in vaginal birth [ 40 ]. Furthermore, evidence highlights the role of midwives in enhancing positive birth beliefs through empathetic, woman-centred, and continuous care [ 42 ].Our findings similarly emphasise that beyond biopsychosocial influences, high-quality midwifery care is pivotal in shaping birth perceptions. Limitations This study was conducted in a specific geographic region, limiting generalisability. Additionally, retrospective accounts from parous women may have been subject to recall bias or changes in perception. Future prospective longitudinal studies, spanning from the antenatal to postpartum periods, are needed to better capture the evolving interplay of biopsychosocial factors. Conclusions This study demonstrates that birth beliefs are multidimensional, shaped through a biopsychosocial framework. Notably, a wider range of biological, psychological, and sociological variables influenced beliefs among nulliparous women, whereas prior birth experience appeared to narrow these influences, functioning as a filter for future perceptions. Clinically, these findings underscore the necessity of holistic, individualised antenatal care—particularly for women without prior birth experience—to strengthen positive attitudes and reduce fear. Socially, the results highlight the importance of enhancing supportive, woman-centred care models, which can foster healthier perceptions of childbirth and contribute to reducing unnecessary medical interventions at the population level. Declarations Ethics approval and consent to participate This study was approved in accordance with the Declaration of Helsinki by the ((Ankara Medipol University Ethics Committee, No: 2025/24). Written informed consent was obtained from all participants prior to data collection. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution SC and HB conceived and designed the study. SC collected the data. OAA and SC performed the statistical analyses. SC, HB, and OAA interpreted the results and drafted the manuscript. All authors read and approved the final version. Acknowledgements The authors would like to thank all the women who participated in this study. Data Availability The datasets generated and analyzed during the current study are not publicly available due to participant privacy and ethical restrictions but are available from the corresponding author on reasonable request. References Preis H, Mor P, Grisaru-Granovsky S, Samueloff A, Gabbay-Benziv R, Chen R, et al. Women's preferences for mode of second birth—A prospective study of two Israeli birth cohorts. 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physiological but a multidimensional life event shaped by emotional, cognitive, and social dynamics [\u0026sup1;]. Birth preferences are influenced not only by physiological needs but also by psychological tendencies and social relationships [\u0026sup2;]. The global rise in caesarean rates currently 21% worldwide with projections reaching 28.5% by 2030, and exceeding 57% in Turkey (the highest rate globally) underscores the need for a systematic, holistic evaluation of determinants of women's birth-related decisions [\u0026sup3;].\u003c/p\u003e \u003cp\u003eThe biopsychosocial model, first proposed by Engel (1977), posits that health-related behaviours should be understood through the dynamic interaction of biological, psychological, and social contexts [⁴]. This framework has proven valuable in understanding complex health decisions, yet its application to birth preferences remains limited. Accordingly, women's birth preferences are shaped by biological factors such as age, pregnancy history, prior birth mode, and health status, alongside partner attitudes for example, perceptions of caesarean safety [⁵]. Psychological variables are equally critical: fear of birth has been linked to loneliness and indecision [6], concern about pain increases caesarean preference [3], whereas self-efficacy promotes vaginal birth [\u0026sup2;,\u0026sup3;]. Studies indicate that approximately 6\u0026ndash;15% of nulliparous women report high fear of childbirth, which significantly influences mode of delivery preferences. Perceived control, traumatic memories, and psychological support further influence decision-making [\u0026sup1;,⁷].\u003c/p\u003e \u003cp\u003eSociological factors also play a decisive role, embedding birth preferences within cultural norms and social support networks. As Kosan et al. (2019) noted, women often follow the guidance of relatives and friends in the absence of adequate knowledge [⁸]. Cross-national studies confirm that cultural values significantly shape caesarean versus vaginal birth choices [⁹,\u0026sup1;⁰].\u003c/p\u003e \u003cp\u003eDespite this evidence, few studies adopt a truly holistic biopsychosocial lens that systematically integrates all three domains, and systematic comparisons between nulliparous women's prospective decisions and parous women's experience-based preferences remain scarce. Understanding these integrated pathways and how prior experience modifies them is critical for developing effective, targeted antenatal interventions and reducing unnecessary caesarean sections. Therefore, this study aimed to examine women's birth beliefs through the biopsychosocial model, using structural equation modelling to identify the biological, psychological, and social determinants and their interrelations. By comparing nulliparous and parous women, the study further sought to clarify how previous birth experience modifies these associations.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch question\u003c/strong\u003e \u003cp\u003eHow do biological, psychological, and social factors collectively influence women's birth beliefs, and does previous birth experience modify the pattern and magnitude of these multidimensional influences?\u003c/p\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eCross-sectional descriptive-analytical study, reported in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Data were collected face-to-face (Feb\u0026ndash;June 2025) using convenience sampling.The application of questionnaires took approximately 30\u0026ndash;45 minutes.\u003c/p\u003e \u003cp\u003eP\u003cb\u003eopulation\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study population consisted of married women aged 18\u0026ndash;45 years residing in Ankara. Eligibility criteria included being literate in Turkish, cognitively able to complete the questionnaire, and either nulliparous or having given birth within the last 10 years. Exclusion criteria were: being unmarried, \u0026lt;\u0026thinsp;18 or \u0026gt;\u0026thinsp;45 years of age, pregnancy at the time of data collection, life-threatening obstetric complications, or language difficulties. A total of 485 women were screened; 47 were excluded (most commonly due to pregnancy, 3.1%). The final sample comprised 438 women, yielding a 90.3% participation rate (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe tool comprised four parts:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDemographic Form\u003c/strong\u003e \u003cp\u003eThis form covers socioeconomic variables such as age, educational status, marital status, income level, partner's education, and employment status.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBiological form\u003c/strong\u003e \u003cp\u003eThis form includes biological variables such as pregnancy history, number of births, mode of birth, previous birth experiences, medical interventions, and health problems.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003ePsychological Scales:\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003ePain Catastrophising Scale (PCS)\u003c/strong\u003e \u003cp\u003eThis scale was developed by Sullivan, Bishop, and Pivik (1995) [\u003csup\u003e11\u003c/sup\u003e ] the Turkish validity and reliability study was conducted by Uğurlu et al. (2017). It has a five-point Likert structure and consists of 13 items in total. The items in the scale are divided into rumination, magnification, and helplessness sub-dimensions. The total score obtained from the scale ranges between 0 and 52, with higher scores indicating a higher tendency to catastrophise pain. The Cronbach alpha coefficient was reported as 0.92 in the Turkish form of the scale [\u003csup\u003e12\u003c/sup\u003e ]. In this study, it was determined as 0.80.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eGeneral Self-Efficacy Scale\u003c/b\u003e: This scale was developed by Sherer et al. (1982) [\u003csup\u003e13\u003c/sup\u003e ] and adapted to Turkish by Yıldırım and İlhan (2010). The scale, which is a five-point Likert type, consists of 17 items and has three sub-dimensions: initiation, persistence, and effort persistence. The score that can be obtained from the scale ranges between 17 and 85, with higher scores indicating that the individual's self-efficacy level is high. The Cronbach alpha coefficient is 0.80 [\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e]. In this study, it was determined as 0.51.\u003c/p\u003e \u003cp\u003e \u003cb\u003eChildhood Trauma Questionnaire (CTQ)\u003c/b\u003e: This scale was developed by Bernstein et al. (1994) [\u003csup\u003e15\u003c/sup\u003e ] and adapted to Turkish by Şar et al. (2012). The scale, which is a five-point Likert type, consists of 28 items. It has five sub-dimensions: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. The total score obtained from the scale ranges between 25 and 125. The Cronbach alpha value is 0.90 [\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e]. In this study, it was determined as 0.119.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePrenatal Fear of Birth Scale\u003c/strong\u003e \u003cp\u003eThis scale was developed by Stoll et al. (2016) [\u003csup\u003e17\u003c/sup\u003e ] and adapted to Turkish by U\u0026ccedil;ar and Taşhan (2017). The scale, which is a six-point Likert type, consists of 10 items and covers dimensions such as birth pain, loss of control, inability to cope with birth, fear of complications, and fear of physical harm. The score that can be obtained from the scale ranges between 10 and 60, with higher scores indicating a higher level of fear. The Cronbach alpha coefficient is 0.86 [\u003csup\u003e18\u003c/sup\u003e ] In this study, it was determined as 0.85.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHealth Anxiety Inventory (HAI)\u003c/strong\u003e \u003cp\u003eThis scale was developed by Salkovskis et al. (2002) [\u003csup\u003e19\u003c/sup\u003e ] and adapted to Turkish by Aydemir et al. (2013). It consists of 18 items in total and has a four-point Likert structure. The first 14 items evaluate health concerns related to the body, whilst the last 4 items evaluate anxiety about the possible negative consequences of illness. The scores obtained from the scale range between 0 and 54, with higher scores indicating higher levels of health anxiety. The Cronbach alpha value of the scale is 0.88 [\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e]. In this study, it was determined as 0.65.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOptimism and Pessimism Scale - Adult Form\u003c/strong\u003e \u003cp\u003eThis scale was developed by \u0026Ccedil;alışkan and Karademir (2023). The scale, which consists of twenty items, has a five-point Likert structure. The total score obtained from the scale indicates the individual's optimism or pessimism orientation. High scores reflect optimism, whilst low scores reflect pessimism. The Cronbach alpha coefficient is 0.87 [\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e]. In this study, it was determined as 0.81.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAttitudes Toward Motherhood Scale\u003c/b\u003e: This scale was developed by Sockol et al. (2014) [\u003csup\u003e22\u003c/sup\u003e ] and adapted to Turkish by Şenyaşar Meterelliyoz et al. (2023). The 12-item structure consists of three sub-dimensions: others' judgements, maternal responsibility, and idealisation of the maternal role. The scores obtained from the six-point Likert scale reflect the cognitive dimension of the individual's attitudes towards motherhood. As the total score increases, the level of cognitive distortion also increases. The Cronbach alpha value of the scale is 0.81[\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e]. In this study, it was determined as 0.80.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSocial Scales\u003c/strong\u003e \u003cp\u003eSocial variables were evaluated with the Multidimensional Perceived Social Support and Partner Support Scales.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eMultidimensional Perceived Social Support Scale (MSPSS)\u003c/b\u003e: This scale was developed by Zimet et al. (1988) [\u003csup\u003e24\u003c/sup\u003e ] and adapted to Turkish by Eker et al. (2001). The scale, which is a seven-point Likert type, consists of 12 items and comprises three sub-dimensions: family, friends, and significant others. The total score obtained from the scale reflects the level of social support. The Cronbach alpha value is 0.89 [\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e]. In this study, it was determined as 0.84.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePartner Support Scale\u003c/b\u003e: This scale was developed by Yıldırım (2004). The scale, which is a three-point Likert type, consists of 27 items and includes four sub-dimensions: emotional support, information and material assistance, appreciation support, and social interest support. High scores obtained from the scale indicate high perceived support from the partner. The Cronbach alpha coefficient was reported as 0.95 [\u003csup\u003e26\u003c/sup\u003e ]. In this study, it was determined as 0.72.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBirth Relief Variable\u003c/strong\u003e \u003cp\u003eDefined as positive beliefs toward vaginal birth, based on 5-point preference item (1\u0026thinsp;=\u0026thinsp;definitely caesarean, 5\u0026thinsp;=\u0026thinsp;definitely vaginal).\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003ePilot and Ethics\u003c/h3\u003e\n\u003cp\u003eContent validity was ensured via three experts. Pilot testing was conducted with 40 women (~\u0026thinsp;10% of the sample). This study received ethics approval from (Ankara Medipol University Ethics Committee, No: 2025/24) and all participants provided written informed consent\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analysed using SPSS 22.0 and AMOS 24.0. Descriptive statistics and Cronbach\u0026rsquo;s α assessed sample and scale properties. Women were classified as parous or nulliparous, and factors influencing birth beliefs were examined using structural equation modelling (SEM) within the biopsychosocial framework. Scale scores were treated as continuous variables. Model fit was evaluated with χ\u0026sup2;/df (\u0026lt;\u0026thinsp;5), CFI (\u0026gt;\u0026thinsp;0.90), GFI (\u0026gt;\u0026thinsp;0.90), and RMSEA (\u0026lt;\u0026thinsp;0.08). Structural paths were reported with β, SE, CR, and p-values.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eData from 438 women were analysed; 46.3% were parous and 53.7% nulliparous. While descriptive statistics were presented for the full sample, SEM analyses were conducted separately for parous and nulliparous groups.\u003c/p\u003e \u003cp\u003eParticipants had a mean age of 32.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5 years, partners 35.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0; mean marriage age was 24.5 with an average duration of 8.2 years. Half were university graduates, 54.3% employed, and 82.9% preferred vaginal birth for future delivery.\u003c/p\u003e\n\u003ch3\u003eScale distributions\u003c/h3\u003e\n\u003cp\u003eDescriptive analyses indicated that most scales approximated normality, although CTQ, HAI, and MSPSS showed deviations. Internal consistency was acceptable overall, except for CTQ and GSES, which demonstrated lower reliability (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean scores of measurement tools and evaluation of normal distributions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasurement Tools\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMax.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eX̄\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal Distribution\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSkewness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eKurtosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGSES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCTQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.592\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eATMS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.555\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.896\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eMin: minimum; Max: maximum; X̄: mean; SD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eBiopsychosocial effects\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNulliparous women\u003c/h2\u003e \u003cp\u003eSEM results indicated significant biopsychosocial determinants of Birth Relief among nulliparous women.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBiological factors\u003c/strong\u003e \u003cp\u003ePositive predictors included privacy assurance (β\u0026thinsp;=\u0026thinsp;.16), parental positive birth experience (β\u0026thinsp;=\u0026thinsp;.12), and dysmenorrhoea (β\u0026thinsp;=\u0026thinsp;.15). Conversely, miscarriage (β=-.17), adverse pregnancy events (β=-.22), menstrual irregularity (β=-.28), and higher age (β=-.13) exerted negative effects.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePsychological factors\u003c/strong\u003e \u003cp\u003eGreater self-efficacy (β\u0026thinsp;=\u0026thinsp;.21), optimism (β\u0026thinsp;=\u0026thinsp;.22), and health anxiety (β\u0026thinsp;=\u0026thinsp;.09) were positive predictors, whereas pain catastrophising (β=-.13), fear of birth (β=-.15), and negative maternal attitudes (β=-.29) were negative. Childhood trauma was non-significant.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSocial factors\u003c/strong\u003e \u003cp\u003eBoth perceived social support (β=-.10) and partner support (β=-.27) were negatively associated with Birth Relief.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eModel fit indices confirmed acceptable fit (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The strongest negative predictors were negative maternal attitudes, menstrual irregularity, and partner support.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of Biopsychosocial Factors on Birth Preference in Nulliparous Women (SEM Results)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLatent Construct\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ₁\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eBiological dimension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor treatment expectation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBelief that privacy will be ensured\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbortion experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMiscarriage experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperiencing negative events during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-5.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParental birth experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDysmenorrhoea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMenstrual regularity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-6.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTrust in healthcare personnel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003ePsychological dimension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGSES Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCTQ Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePFBS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHAI Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOPS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eATMS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-6.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eSocial dimension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceived social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePartner support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-6.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eSE: Standard error; β: standardised path coefficients; β₁: unstandardised path coefficients; t: t-statistic; p: significance level.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParous women\u003c/h2\u003e \u003cp\u003eSEM analysis among parous women identified fewer significant predictors of Birth Relief.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBiological factors\u003c/strong\u003e \u003cp\u003ePrivacy provision (β\u0026thinsp;=\u0026thinsp;.17, p\u0026thinsp;=\u0026thinsp;.007) and receiving adequate attention (β\u0026thinsp;=\u0026thinsp;.17, p\u0026thinsp;=\u0026thinsp;.007) were positively associated with Birth Relief.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePsychological factors\u003c/strong\u003e \u003cp\u003eHealth anxiety emerged as a negative predictor (β=-.23, p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSocial factors\u003c/strong\u003e \u003cp\u003ePerceived social support also showed a negative association (β=-.15, p\u0026thinsp;=\u0026thinsp;.013), whereas partner support was non-significant.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAll other variables did not reach significance (p\u0026thinsp;\u0026gt;\u0026thinsp;.05). Model fit indices confirmed acceptable model adequacy (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffects of Biopsychosocial Factors on Birth Preference in Parous Women (SEM Results)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLatent Construct\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ₁\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eBiological dimension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRegular menstruation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDysmenorrhoea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative experience during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical space inadequacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor treatment experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostpartum health problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEpisiotomy experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrivacy provision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReceiving adequate attention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExperiencing chronic illness during pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMode of last birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003ePsychological dimension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGSES Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCTQ Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePFBS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHAI Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-3.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOPS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eATMS Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLoneliness Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eSocial dimension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceived social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth Relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePartner support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eSE: Standard error; β: standardised path coefficients; β₁: unstandardised path coefficients; t: t-statistic; p: significance level.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study, the first to address birth preferences within a biopsychosocial framework.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBiological factors\u003c/h2\u003e \u003cp\u003eAmong nulliparous women, predictors of birth beliefs included privacy, pregnancy loss, adverse antenatal events, parental birth experiences, dysmenorrhoea, menstrual regularity, and age; among parous women, privacy and feeling adequately attended to were influential. Privacy was a positive determinant in both groups, consistent with studies showing that safeguarding autonomy enhances confidence but may also lead some women to prefer caesarean birth [\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e]. Pregnancy loss was linked to more negative beliefs [\u003csup\u003e28;29,30\u003c/sup\u003e], as were adverse antenatal experiences [\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e]. Positive parental birth narratives predicted favourable beliefs, reflecting cultural transmission [\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e]. Dysmenorrhoea and irregular cycles correlated with negative beliefs [\u003csup\u003e\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e]. Increasing age was associated with perceiving birth as risky, supporting evidence of higher caesarean preference with older maternal age [\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e]. Among parous women, respectful and attentive care predicted more positive beliefs, in line with prior work emphasising professional and emotional support [\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e]. Collectively, these findings highlight the influence of both individual (e.g.,miscarriage, menstrual health, adverse experiences) and cultural/environmental (e.g.,parental narratives, age) factors on birth beliefs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePsychological factors\u003c/h2\u003e \u003cp\u003eAmong nulliparous women, higher pain catastrophising was linked to less positive birth beliefs, consistent with findings that difficulty coping with pain negatively shapes expectations [\u003csup\u003e\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e]. Health anxiety showed a complex pattern: while higher anxiety correlated with more positive beliefs among nulliparous women, possibly reflecting proactive engagement, it was associated with reduced confidence in vaginal birth among parous women, aligning with evidence that medicalised anxiety influences caesarean preference [\u003csup\u003e3,\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e0,41\u003c/sup\u003e]. Optimism was positively related to birth beliefs, whereas pessimistic experiences predicted more negative preferences, regardless of mode of birth [\u003csup\u003e1\u003c/sup\u003e]. Negative attitudes toward motherhood among nulliparous women also predicted less favourable beliefs about vaginal birth, suggesting that antenatal education addressing maternal role perceptions may support healthier preferences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSociological factors\u003c/h2\u003e \u003cp\u003eAcross both groups, higher perceived social support was paradoxically linked to more negative birth beliefs, though prior studies reported positive associations, suggesting that effects may depend on the type and quality of support [\u003csup\u003e39,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e]. Among nulliparous women, reduced partner support predicted more negative beliefs, consistent with findings that strong partner support fosters confidence in vaginal birth [\u003csup\u003e40\u003c/sup\u003e]. Furthermore, evidence highlights the role of midwives in enhancing positive birth beliefs through empathetic, woman-centred, and continuous care [\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e].Our findings similarly emphasise that beyond biopsychosocial influences, high-quality midwifery care is pivotal in shaping birth perceptions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study was conducted in a specific geographic region, limiting generalisability. Additionally, retrospective accounts from parous women may have been subject to recall bias or changes in perception. Future prospective longitudinal studies, spanning from the antenatal to postpartum periods, are needed to better capture the evolving interplay of biopsychosocial factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates that birth beliefs are multidimensional, shaped through a biopsychosocial framework. Notably, a wider range of biological, psychological, and sociological variables influenced beliefs among nulliparous women, whereas prior birth experience appeared to narrow these influences, functioning as a filter for future perceptions. Clinically, these findings underscore the necessity of holistic, individualised antenatal care\u0026mdash;particularly for women without prior birth experience\u0026mdash;to strengthen positive attitudes and reduce fear. Socially, the results highlight the importance of enhancing supportive, woman-centred care models, which can foster healthier perceptions of childbirth and contribute to reducing unnecessary medical interventions at the population level.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved in accordance with the Declaration of Helsinki by the ((Ankara Medipol University Ethics Committee, No: 2025/24). Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSC and HB conceived and designed the study. SC collected the data. OAA and SC performed the statistical analyses. SC, HB, and OAA interpreted the results and drafted the manuscript. All authors read and approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to thank all the women who participated in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to participant privacy and ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePreis H, Mor P, Grisaru-Granovsky S, Samueloff A, Gabbay-Benziv R, Chen R, et al. Women's preferences for mode of second birth\u0026mdash;A prospective study of two Israeli birth cohorts. 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Cochrane Database Syst Rev. 2024;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD004667\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD004667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Biopsychosocial Model, Birth, Birth Belief, Birth Preference, Women","lastPublishedDoi":"10.21203/rs.3.rs-8140390/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8140390/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBirth preferences significantly influence maternal psychological wellbeing and healthcare outcomes, yet are shaped by complex, interacting factors. Understanding these pathways is critical for developing effective interventions to support women's decision-making and reduce unnecessary caesarean sections. This study was conducted to examine women's birth beliefs through the biopsychosocial model using structural equation modelling, and to compare the biological, psychological, and social determinants between nulliparous and parous women.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eCross-sectional study of 438 married women (18\u0026ndash;45 years) in Ankara, Turkey (February\u0026ndash;June 2025). Participants completed assessments of biological factors, seven psychological scales, two social support measures, and a birth preference item. Structural equation modelling identified predictive pathways separately for nulliparous (53.7%) and parous (46.3%) groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong nulliparous women, 15 predictors significantly influenced birth beliefs: seven biological (privacy belief, miscarriage, negative pregnancy events, parental birth experience, dysmenorrhoea, menstrual regularity, age), six psychological (pain catastrophizing, self-efficacy, fear of birth, health anxiety, optimism, maternal attitudes), and two social (perceived social support, partner support). Among parous women, only four factors were significant: privacy provision, adequate attention, health anxiety, and perceived social support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBirth beliefs are genuinely multidimensional, shaped by interacting biopsychosocial factors. Nulliparous women are influenced by substantially more factors than parous women, suggesting that direct birth experience functions as a powerful filter for future beliefs. Comprehensive, individualized antenatal care addressing all three domains particularly for first time mothers may strengthen positive birth beliefs and reduce unnecessary caesarean sections.\u003c/p\u003e","manuscriptTitle":"Examination of the Factors Influencing Women's Birth Beliefs According to the Biopsychosocial Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:07:44","doi":"10.21203/rs.3.rs-8140390/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-12-12T09:25:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-18T08:56:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T06:54:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-18T06:52:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-11-18T03:11:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"878e8ff2-b083-4bfa-a84e-8e49b48c37e3","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T09:07:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 09:07:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8140390","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8140390","identity":"rs-8140390","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}