The Mediating Role of Family cohesion and adaptability in the relationship between self-efficacy and fear of childbirth among primiparous women

Objective To examine the effect of self-efficacy on fear of childbirth（FOC) among primiparous women and to assess the mediating roles of family cohesion and adaptability. Methods Using convenience sampling, we recruited 482 primiparous women from the obstetric clinics of two “AAA” hospitals in Taiyuan City between January and September 2025. Participants completed standardized scales measuring general information, childbirth attitudes, childbirth self-efficacy, family cohesion, and adaptability. Data were analyzed using descriptive statistics, t-tests, one-way ANOVA, and Pearson correlation. A structural equation modeling (SEM) approach was used to test the proposed mediation model. Results The mean scores for fear of childbirth and self-efficacy were 41.80±11.48 and 74.76±22.28, respectively, both below the reported national averages. Pearson correlation analysis showed that self-efficacy was positively correlated with family cohesion (r=0.51, P<0.05) and adaptability (r=0.48, P<0.05), but negatively correlated with childbirth fear (r=-0.24, P<0.05). Family cohesion and adaptability were negatively correlated with childbirth fear (r=-0.52, P<0.05 and r=-0.50, P<0.05). After controlling for age and preferred delivery method, regression analysis and mediation testing indicated that the mediation effects of family cohesion and adaptability accounted for 52.1% and 47.2%, respectively. Conclusion Self-efficacy not only directly mitigates fear of childbirth in primiparous women but also exerts an indirect effect by enhancing family cohesion and adaptability.In the process of reducing the fear of childbirth, family members should be encouraged to provide more family support to primiparous women, and the self-efficacy of primiparous women should be highly valued.