Information and Progressive Relaxation Exercises

There is an increase in the frequency of cesarean sections worldwide (Abdelrahman et al., 2020). WHO states that approximately 18.6 million cesarean sections are performed annually. It is observed that the frequency of cesarean sections in Turkey is increasing every year. According to the Health Statistics Yearbook 2021 data, the rate of cesarean sections in live births is 58.4%, and the rate of primary cesarean sections in live births is 29.1%. These rates show that they are well above the ideal cesarean rate determined by WHO, which should be between 10-15%.

Although there are many known reasons for the increase in cesarean sections, more than 80% of women experience fear and anxiety before and during cesarean sections (Abarghoee et al., 2022; Salmanzadeh et al., 2018). A significant portion of women who undergo cesarean sections experience high levels of anxiety before the procedure (Maleki et al., 2022). Studies show that 63-86% of women who undergo cesarean section have higher levels of fear and anxiety compared to those who undergo general surgery (Ferede et al., 2022). Anxiety related to cesarean section surgery has been associated with physiological and psychological risks. Fear and anxiety experienced before cesarean section can trigger responses from both the sympathetic and parasympathetic nervous systems, as well as affecting hormone levels. As a result, these responses can lead to increased blood pressure and heart rate, and cardiac arrhythmia (Koca et al. 2021). In addition, excessive fear and anxiety before and during surgery can lead to anesthesia complications, increased need for postoperative pain relief, prolonged recovery, delayed initiation of breastfeeding and discharge, higher costs, and decreased satisfaction with the birth experience (Schaal et al. ., 2020 and Hepp et al., 2018). Therefore, it is particularly important to address and reduce fear and anxiety related to cesarean section, as lower levels of fear and anxiety before and during surgery have been associated with greater maternal satisfaction and a more positive overall birth experience (Noben et al., 2019). Managing fear and anxiety can be approached using both pharmaceutical and non-pharmacological methods. Although pharmaceutical approaches are widely used, they can be expensive, sometimes painful, and carry the potential risk of adverse effects on the fetus if they cross the placenta (Eslami et al., 2020). Therefore, there is a focus on using non-pharmacological techniques to alleviate fear and anxiety in women undergoing cesarean section (Abadi et al., 2018). One effective example is the use of relaxation techniques to reduce fear and anxiety (Vagnoli et al., 2019). Frequently used methods include meditation, massage therapy, muscle relaxation exercises, acupuncture, energy healing applications, different breathing techniques such as controlled breathing or diaphragmatic breathing (Mohamady et al. 2022). Relaxation exercise is associated with decreased oxygen consumption levels and decreased activity in the sympathetic nervous system (Ibrahim et al., 2019). One of the known methods of achieving relaxation is progressive relaxation exercise (PGE). Technically, PGE involves the voluntary, systematic tension and complete relaxation of large muscle groups until relaxation is achieved throughout the body. The aim is to ensure that the individual can relax on their own in their daily lives by feeling the difference between tension and relaxation in their body and mind (Burke et al. 2011; Özveren 2011). Considering the high incidence of cesarean section and the prevalence of anxiety and fear as psychological symptoms, it is of great importance to provide comfort and pain support to women. Therefore, the aim of this study was to determine the effects of planned pre-cesarean information and progressive relaxation exercises on surgical fear, anxiety, postpartum comfort and pain levels of primiparous women.

• Visual Analog Scale (VAS) [Time frame: 3 month]
• postpartum comfort scale [Time frame: 3 month]