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

Background Birth 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. 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.