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Introduction Sociodemographic and obstetric factors have been shown to impact childbirth experience, but results regarding the effect of certain factors have been heterogeneous. It is important to understand how individual risk factors affect childbirth experience to be able to identify women at risk for negative childbirth experience. The aim of this study was to determine individual associations between sociodemographic and obstetric factors and childbirth experience. Material and Methods The Labor Progression Study (LaPS‐NCT02221427) was a multicenter randomized trial examining clinical consequences of using Zhang's guideline vs the WHO partograph on intrapartum cesarean section rate. Four weeks after delivery, 5810 women received the Childbirth Experience Questionnaire (CEQ) online. The CEQ consists of 19 questions on four subscales (own capacity, professional support, perceived safety, and participation). The total CEQ score is the mean score of each of the subscale scores, ranging from 1 to 4, a higher score indicating a better childbirth experience. Sociodemographic (age, body mass index, education, civil status, and smoking) and obstetric (gestational age, prolonged labor, mode of delivery, and obstetric complications) characteristics of the women were recorded, and associations to total and subscale CEQ scores were examined with log‐linear regression. Results In all, 3604 women answered the questionnaire, a 62.9% response rate. The mean (SD) total CEQ score was of 3.24 (0.43). The subscale score was highest for professional support, mean 3.68 (0.49), and lowest for own capacity, mean 2.61 (0.54). The total CEQ score was not associated with any of the sociodemographic characteristics examined. Smoking in the first trimester was associated with lower scores on the professional support subscale 3.61 (3.55, 3.67) than nonsmokers, 3.69 (3.68, 3.71); p = 0.001. Of obstetric factors, only delivering in week 37 was significantly associated with a higher total CEQ score, 3.34 (3.28, 3.40), vs. 3.24 (3.22, 3.26) at 40 weeks, p = 0.002. Findings remained significant in adjusted analysis. Conclusions In our study, individual sociodemographic factors did not impact overall the childbirth experience. Smoking was associated with a lower score on the professional support subscale. Delivery in week 37 was associated with a better overall childbirth experience. No other obstetric factor influenced the childbirth experience. Individual sociodemographic and obstetric factors have little influence on childbirth experience in first‐time mothers when intrapartum and postpartum care is of a good standard.

Objective This study aimed to evaluate the effect of maternal active pushing during cesarean section (CS) on postoperative pain, intraoperative discomfort, and the mother’s sense of control and participation. Design A prospective, randomized controlled study. Methods Patients were randomly assigned into two groups. In the Conventional group ( n  = 45), the CS was performed traditionally without maternal pushing. In the Assisted group ( n  = 55), patients were instructed to push during delivery. Outcomes measures included patients’ perceived pressure, pain, and sense of participation. Breastfeeding and postnatal depression were assessed using validated scales, along with maternal and neonatal outcomes, surgeon satisfaction, and operation duration. Results Patients in the Assisted group reported significantly lower fundal pressure intensity (VAS score 3 vs. 5, P  < 0.01) compared to the Conventional group. There was no significant difference in postoperative pain. However, women in the Assisted group reported a greater sense of participation (6 vs. 0, P  < 0.01) and control (4 vs. 0, P  < 0.05) than those in the Conventional group. No significant maternal or neonatal complications were observed. Conclusion Maternal active pushing during CS positively impacted intraoperative experience by reducing perceived pressure and enhancing the sense of control and participation, without adverse effects on maternal or neonatal outcomes. These findings support further research with larger, multi-center studies to validate the potential benefits of this approach. Trial Registration NCT05520580 ( https://clinicaltrials.gov/ct2/show/NCT05520580 ).

Background Stress and anxiety during pregnancy and childbirth have negative consequences for both mother and child. There are indications that music has a positive effect in this situation. The present study investigates the influence of music during the caesarean on anxiety and stress of the expectant mother. Methods The SAMBA study is a single-centre, controlled, randomized study including 304 patients. Women in the intervention group heard music via loudspeakers from one of four self-selected genres. The control group had standard treatment without music. The caesarean was performed in regional Anesthesia. At admission, at skin incision, during skin suture and two hours after completion of surgery, different subjective (State-Trait Anxiety Inventory, visual analogue scale for anxiety) and objective parameters (salivary cortisol/amylase, heart rate, blood pressure) were collected. Mixed-factorial Analysis of variances as well as independent sample t-tests were applied for data analysis. Results At skin suture, significantly lower anxiety levels were reported in the intervention group regarding State anxiety (31.56 vs. 34.41; p  = .004) and visual analogue scale for anxiety (1.27 vs. 1.76; p  = .018). Two hours after surgery, the measured visual analogue scale for anxiety score in the intervention group was still significantly lower (0.69 vs. 1.04; p  = .018). The objective parameters showed significant differences between the groups in salivary cortisol increase from admission to skin suture (12.29 vs. 16.61 nmol/L; p  = .043), as well as systolic blood pressure (130.11 vs. 136.19 mmHg; p  = .002) and heart rate (88.40 vs. 92.57/min; p  = .049) at skin incision. Conclusions Music during caesarean is an easy implementable and effective way of reducing stress and anxiety of the expectant mother. Trial registration German registry for clinical trials ( DRKS00007840 ). Registered 16/06/2015. Retrospectively registered.

Background Breastfeeding provides significant benefits for both mothers and infants, yet its rates remain suboptimal, particularly among women undergoing cesarean sections. Breastfeeding practices are determined by a wide range of socio-environmental, cultural, family and individual factors, but current breastfeeding promotion interventions that integrate these dimensions are limited. This study aimed to evaluate the effectiveness of a breastfeeding intervention based on Theory of Planned Behavior and the Interactive Theory of Breastfeeding in promoting breastfeeding outcomes in women after cesarean section. Methods A total of 763 women were recruited and randomly divided into an intervention group ( n  = 383) and a control group ( n  = 380). The participants were women scheduled for elective cesarean sections due to medical indications. On the basis of theory, mothers in the intervention group received the breastfeeding promotion program, focusing on enhancing breastfeeding knowledge, fostering positive attitudes, increasing family support, strengthening perceived behavioral control, facilitating the transition from intention to action, and promoting mother-infant interaction through skin-to-skin contact, responsive feeding, and emotional bonding. The control group received routine nursing care. Outcomes were assessed using the Bristol Breastfeeding Assessment Tool and the Chinese Breastfeeding Attrition Prediction Tool, focusing on exclusive breastfeeding rates, breastfeeding frequency, duration, and complications. Results The exclusive breastfeeding rates in the intervention group were significantly higher on day 1, day 2 And day 3 after cesarean section compared to the control group ( P  < 0.001). The intervention group exhibited higher Bristol Breastfeeding Assessment Tool and Chinese Breastfeeding Attrition Prediction Tool scores, improved breastfeeding frequency and duration, and a lower incidence of breastfeeding-related complications ( P  < 0.05). Conclusion A theory-based nursing intervention integrating Theory of Planned Behavior and the Interactive Theory of Breastfeeding significantly enhanced exclusive breastfeeding rates and maternal breastfeeding behaviors in women after cesarean sections. This study highlights the value of combining psychological and contextual factors to design effective breastfeeding interventions, providing evidence for scalable and sustainable strategies to support breastfeeding in postpartum care. Trial registration This trial was retrospectively registered with the Chinese Clinical Trial Registry on November 19th, 2024 (ChiCTR2400092869) .

To assess the effectiveness of WeChat-based continuity nursing in reducing postpartum depression and improving the quality of life among primiparous women undergoing cesarean delivery. A total of 200 patients who intended to undergo cesarean delivery in our hospital between January 2021 and January 2022 were recruited for this study, including 20 patients who refused to participate in the study and 30 patients who did not meet the criteria of this study for various reasons, and a total of 150 cases were finally included. All participants were assigned 1:1 into the control group and observation group according to the time of the first pregnancy test and the primiparous in the observation group were given WeChat continuity nursing, and the primiparous in the control group was given routine obstetric care. WeChat continuity nursing included establishment of continuity nursing team, WeChat group setup and communication, education and support, and psychological counseling and follow-up. The baseline data of all mothers were collected and recorded, and the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), quality of life scores, maternal and infant complications, and the satisfaction rate of care were compared between the two groups. The SAS and SDS scores of the observation group were consistently lower than those of the control group at 1, 3, and 6 months post-hospital discharge (P < .01). Following the implementation of WeChat continuity nursing intervention, patients in the observation group demonstrated significant improvements in mental health, physical function, somatic pain, vitality, and social function scores compared to the control group (P < .01). Additionally, the incidence of complications was notably lower in the observation group, including reduced rates of incisional infection, breast swelling, unclear dew, abnormal defecation among mothers, and decreased occurrence of breech redness, umbilical cord issues, eczema, and delayed umbilical cord detachment among infants (P < .05). Moreover, the satisfaction rate among patients in the observation group was significantly higher than that of the control group (95.507% vs. 84.058%) (P < .05). These findings highlight the efficacy and importance of integrating WeChat continuity nursing intervention into postpartum care practices. Our study strongly supports the effectiveness of WeChat continuity nursing intervention in improving postpartum mental health, reducing complications, and increasing patient satisfaction. These findings suggest the potential for integrating digital nursing interventions into standard postpartum care practices, offering personalized and accessible healthcare services. Policymakers and healthcare providers should consider adopting such interventions to optimize postpartum outcomes and enhance patient experiences.

Background Due to the deterioration in comfort experienced after cesarean section, mothers go through troubled hours, have problems with breastfeeding, and cannot even meet their own and their baby’s needs. This study was conducted to determine the effect of neuro-linguistic programming on mothers’ comfort levels following cesarean section in the postpartum period. Methods This study was performed from 1 January to 1 September 2023 as a prospective randomized controlled single-blind clinical trial with 100 participants (50 experimental, 50 control). The research data were collected using the Personal Information Form and the Postpartum Comfort Scale. The dependent samples t test and independent samples t test were used in the analysis of research data as well as numbers, percentages, and means. Analysis of covariance (ANCOVA) was used to evaluate the effect of the NLP more accurately by controlling the pre-test scores. Results There were statistically significant differences between the mean pretest and posttest postpartum comfort scale scores, physical comfort scores, psycho-spiritual comfort scores, and sociocultural comfort scores of mothers in the intervention group. In this regard, mothers in the intervention group had higher mean postpartum comfort scale scores, physical comfort scores, psycho-spiritual comfort scores, and sociocultural comfort scores in the posttest phase than in the pretest phase. Conclusions This study revealed that neuro-linguistic programming enhanced the postpartum comfort levels of mothers who underwent cesarean delivery. In this context, it is recommended that nurses and midwives enhance participants’ comfort through the use of neuro-linguistic programming techniques in care processes. Trial registration NCT05646537.

Background Cesarean delivery rates have risen in recent years, often influenced by misconceptions and negative attitudes rather than medical necessity. To address this issue, the present study examined the impact of an educational intervention based on the Theory of Planned Behavior (TPB) on delivery method choice among primiparous women in Firouzabad, Iran (2024–2025). Methods This quasi-experimental study was conducted on 100 primiparous women covered by health centers in Firouzabad County, Fars Province, Iran, from 2024 to 2025. Sampling combined cluster and simple random methods to intervention ( n  = 50) and control ( n  = 50) groups. The intervention group received six 60-minute in-person educational sessions at health centers over two months. Data were collected using a standardized TPB-based questionnaire completed by both groups before and two months’ post-intervention. Data were analyzed in SPSS-27 using paired t-tests, independent t-tests, chi-square, and Fisher’s exact tests. Results Independent t-tests showed no significant differences in mean scores of knowledge ( p  = 0.842), attitude ( p  = 0.456), subjective norm ( p  = 0.215), perceived behavioral control ( p  = 0.751), or behavioral intention ( p  = 0.612) between groups before the intervention. Post-intervention, however, the intervention group demonstrated significantly higher mean scores across all TPB constructs compared to the control group ( p  < 0.001), indicating the effectiveness of the educational program. Conclusion The results of the present study demonstrated that the educational intervention based on the TPB was effective in establishing behavioral intention for selecting natural delivery type among primiparous women. This research revealed that TPB-based education, through identifying misconceptions and addressing incorrect social norms, successfully promoted behavioral intention in primiparous women, enabling them to choose the optimal delivery method according to their circumstances.

BackgroundChoice of postcesarean delivery analgesic protocol may improve pain experience and reduce analgesic requirements.MethodsCesarean delivery patients were randomly assigned either to choose their postcesarean delivery analgesia protocol or to have no choice and receive routine care. Choices were low (50 μg intrathecal morphine), medium (identical to routine care: 150 μg intrathecal morphine), or high (300 μg intrathecal morphine with 600 mg oral gabapentin). All groups received scheduled acetaminophen and ibuprofen. The primary outcome was oxycodone requirements 0–48 hours postdelivery in those offered versus not offered a choice.ResultsOf 160 women enrolled, 120 were offered a choice and 40 were not offered a choice. There was no difference in oxycodone requirements or pain associated with choice, but those who had a choice expressed more satisfaction than those who did not have a choice (mean (95% CI) difference 5% (0% to 10 %), p=0.005). In the choice group, the high dose group required more oxycodone (5 (0 to 15) mg 0–24 hours after delivery and 15 (10 to 25) mg at 24–48 hours; p=0.05 and p=0.001) versus the low and medium groups. The low dose group had less pruritus (p=0.001), while the high dose group had more vomiting (p=0.01) requiring antiemetic treatment (p=0.04).ConclusionHaving a choice compared with no choice routine care did not reduce oxycodone requirements or pain scores. However, women have insight into their analgesic needs; women offered a choice and who chose the higher dose analgesic protocol required more oxycodone, and women who chose the lower dose protocol required less oxycodone. Despite providing additional analgesic (six times more intrathecal morphine plus gabapentin in high dose vs low dose protocols), we still did not equalize postcesarean oxycodone requirement differences between groups.Trial registration number NCT02605187.

Background and aim Telling stories about giving birth vaginally can generate deeper understandings, potentially resulting in fewer requests to birth via cesarean section without medical reason. We aimed to determine the impact of the digital storytelling of peers’ childbirth experiences on the perception and mode of childbirth in those birthing for the first time. Methods This quasi-experimental study invited those pregnant and birthing for the first time from four comprehensive health centers to participate. Using a simple randomizing method, two centers were assigned to the control group and two centers were assigned to the intervention group. Convenience sampling was used to recruit 65 eligible participants from each center group. The six steps of the ASPIRE model were used to guide the development of the intervention. Five story-telling videos were sent weekly to participants in the intervention group to watch between the 32nd and 36th weeks of pregnancy. After giving birth, data were collected via telephone from those in both the control and intervention groups in relation to their mode of childbirth as a primary outcome. Furthermore, 7 to 21 days after giving birth, all participants completed the Childbirth Perception Scale as a primary outcome. Results Our subgroup analysis confirmed a statistically significant difference between both the intervention and control groups ( P  = 0.001), whereby those who gave birth vaginally in the intervention group indicated more positive perceptions of childbirth. Contrariwise, no significant difference was identified between the intervention and control groups in terms of perception of childbirth score in participants who gave birth via emergency cesarean section ( P  = 0.45). In all included participants, that is, those who experienced vaginal childbirth and those who experienced emergency cesarean section, there was no significant difference identified between the intervention and control groups in terms of perception of childbirth score ( P  = 0.088). Conclusion The digital storytelling of peers’ childbirth experiences is effective in cultivating more positive perceptions in relation to the experience of childbirth, specifically among those who experience childbirth vaginally. Considering the above, digital storytelling may be implemented as a useful tool in childbirth preparation, though the need for alternative interventions remains in pursuit of lowering the number of unnecessary births via cesarean section conducted overall.

The frequency of definitive childlessness in women with multiple sclerosis (MS) may be higher than in the general population. MS may also affect decisions on the delivery procedure and on breast-feeding issues. Aim of the study was to assess the frequency of childlessness and its possible causes, the proportion of cesarean deliveries (CD), and the frequency of breast-feeding in patients and controls who have reached the end of their reproductive period. Female MS patients (>43 years) and controls (>45 years) filled out a questionnaire. We enrolled 303 patients and 500 controls. MS was associated with a higher frequency of childlessness (22 vs 13%) and less patients were in a stable relationship (83 vs 89%). There was no difference in the reported rates of infertility and miscarriages, while elective abortions were more frequent in patients (20 vs 12%). MS did not significantly affect the frequency of CD or of breast-feeding. MS-related reasons for childlessness, reported by 16% of childless patients, included disability/fear of future disability, fear of genetically transmitting MS, fear of not starting/discontinuing treatments, and discouragement by physician. Definitive childlessness is more frequent in women with MS compared to controls. A portion of voluntary childlessness may be avoided through correct/tailored information to patients.