Impact of antenatal education on vaginal birth and cesarean rates in a secondary care setting

Cesarean section rates are rising globally, often exceeding recommended levels and posing risks for maternal and neonatal health. Beyond clinical indications, behavioral and informational factors such as fear of childbirth, misconceptions, risk perception, and provider influence can shape delivery preferences. Antenatal education programmes address these determinants by improving knowledge, reducing fear, and supporting informed decision-making. However, evidence from routine health service settings remains limited, particularly on their contribution to reducing primary cesarean sections. This practice-based analysis used routine delivery data from 2025 in a secondary care hospital in Türkiye. Women were categorized according to attendance to antenatal education programmes. The objective was to evaluate whether participation was associated with delivery mode. Vaginal birth rates, cesarean section rates, and primary cesarean section rates were compared between attendees and non-attendees in routine care. Vaginal birth was more common among women who attended antenatal education programmes than among non-attendees (58.2% vs 42.1%), while cesarean section rates were lower in the education group (41.8% vs 57.9%). The difference was notable for primary cesarean sections, which were less frequent among attendees (19.0% vs 32.4%). These findings suggest that antenatal education may support vaginal birth and help reduce first-time cesarean deliveries in routine care. Antenatal education programmes may serve as a scalable, low-cost intervention to support informed delivery decisions and reduce unnecessary cesarean sections. By addressing fear, knowledge gaps, expectations, and misconceptions, these programmes may help prevent the cesarean cascade. Integrating antenatal education into routine maternal care could support sustainable, woman-centered, and evidence-informed childbirth practices in similar settings seeking to optimize delivery outcomes.

Key messages

• Antenatal education was associated with higher vaginal birth rates and lower primary cesarean rates in a real-world hospital setting.

• Scaling antenatal education programmes may reduce unnecessary cesarean sections by improving decision-making and reducing fear of childbirth.