The aim of this study was to examine the relationships between perceived stress during pregnancy, ruminative responses, self-efficacy regarding vaginal birth and to test whether perceived stress during pregnancy mediates the relationship between self-efficacy regarding vaginal birth and ruminative responses. In this cross-sectional and correlational study, 351 pregnant women were reached. Associations were confirmed using structural equation modeling and linear regression analysis. The study’s findings provide a deeper understanding of the psychological mechanisms that influence women’s childbirth preferences. Self-efficacy perception regarding vaginal birth has a significant indirect effect on ruminative responses through perceived stress during pregnancy (β = −0.147, p = 0.014). These results highlight the potential role of perceived stress as a psychological mechanism linking self-efficacy and ruminative thinking. Clinically, interventions aimed at reducing stress and supporting self-efficacy such as tailored antenatal care and psychological support may help enhance women’s confidence in vaginal birth and support their childbirth preferences. Future longitudinal studies are recommended to further examine these relationships.
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