Impact of Quran Recitation on Labor Pain, Maternal Comfort, and Blood Pressure: A Quasi-Experimental Study in Nulliparous Women

Impact of Quran Recitation on Labor Pain, Maternal Comfort, and Blood Pressure: A Quasi-Experimental Study in Nulliparous Women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Quran Recitation on Labor Pain, Maternal Comfort, and Blood Pressure: A Quasi-Experimental Study in Nulliparous Women Widad Al Kharusi, Sophia Cyril Vincent, Fatima Al Muqbali, Aysha Al Hashmi Al Hashmi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8666369/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background : Labor pain and childbirth comfort significantly affect maternal satisfaction, labor progression, and psychological well-being. Non-pharmacological methods are increasingly explored to manage labor pain safely and holistically. Quran recitation, a culturally and spiritually rooted auditory intervention, may offer psychological and physiological benefits during childbirth. Objective : To evaluate the effectiveness of Quran recitation in reducing labor pain intensity, comfort during childbirth, and blood pressure among nulliparous women in Oman. Methods : A quasi-experimental study was conducted at Khoula Hospital, Oman, involving 120 nulliparous women with singleton term pregnancies. Participants were assigned to either the Quran recitation group (n = 60) or the back massage group (n = 60). Data were collected using the Visual Analogue Scale (VAS), Pain Behavioral Observation Scale (PBOS-3), Childbirth Comfort Questionnaire (CCQ), and physiological measures of blood pressure. Pre- and post-intervention comparisons were performed using paired t-tests and ANOVA. Results : Quran recitation significantly reduced mean VAS pain scores (76.45 ± 8.20 to 58.32 ± 7.16, p = 0.001) compared to back massage, which showed a non-significant change (62.88 ± 8.44 to 61.10 ± 7.98, p > 0.05). The intervention group also demonstrated significant improvements in pain behaviors, comfort levels (total CCQ score p = 0.002), and reductions in systolic and diastolic blood pressure ( p = 0.001). Conclusion : Quran recitation is a safe, culturally congruent, and effective non-pharmacological intervention for reducing labor pain and enhancing maternal comfort. It has physiological calming effects and can be considered as a complementary strategy in obstetric care for Muslim women. Quran recitation labor pain childbirth comfort blood pressure non-pharmacological interventions spiritual care nulliparous women Oman Figures Figure 1 Introduction Labor pain is one of the most intense and distressing forms of pain experienced by women, and it significantly shapes their perceptions of childbirth, future reproductive choices, and overall maternal satisfaction. The pain arises from the stretching and dilation of the cervix, vagina, and perineum, along with strong and rhythmic uterine contractions. 1 Anxiety, which commonly accompanies labor, intensifies the perception of pain and can adversely affect the course of childbirth. 2 Elevated stress hormones such as adrenaline and cortisol triggered by severe pain and fear of labour, reduce uterine efficiency, prolong labor, and increase the risk of maternal and neonatal complications. ³ Prolonged labor can further contribute to maternal exhaustion, infection, physical strain, neurological stress, and sleep disturbances, highlighting the importance of effective pain-management strategies. 4–5 Uncontrolled labor pain also carries long-term psychological consequences, including traumatic birth experiences, heightened childbirth discomfort, and increased risk of postpartum depression. Globally, nearly 75–85% of expectant mothers report significant anxiety in the period leading up to labor, underscoring the need for interventions that address both physical pain and emotional distress. 6 Inadequate pain relief has additionally been associated with increased cesarean section (CS) rates is a concern in Oman, where CS rates rose from 15.72% in 2009 to 21.7% in 2020 which is drastically increased to 26% in 2024. 7 These trends reinforce the need for safe, acceptable, and effective pain-management strategies for women, particularly primi gravida who often experience heightened labour pain and childbirth comfort. While pharmacological approaches such as epidural analgesia remain the gold standard for labor pain relief, they can be associated with side effects such as hypotension, prolonged labor, and increased rates of instrumental delivery. 8 This has encouraged greater interest in non-pharmacological interventions, which are valued for their safety, minimal invasiveness, and ability to promote maternal autonomy and relaxation. Auditory techniques such as music therapy have been shown to reduce anxiety, stabilize blood pressure, and increase pain thresholds by promoting psychological calmness. 9 Similarly, tactile methods like massage facilitate circulation, stimulate endorphin release, and relieve muscle tension, resulting in reduced pain intensity and improved maternal comfort. 10 Techniques such as Kimber’s massage and oil-based massage have demonstrated significant reductions in labor pain and decreased need for pharmacological analgesia. 11 In culturally rooted contexts such as Oman, spiritual auditory interventions offer additional relevance. Quran recitation, characterized by rhythmic and melodic verses, has been shown to promote relaxation, reduce pain perception, lower blood pressure, and enhance maternal satisfaction in various clinical settings. 12 – 13 However, despite its cultural and spiritual significance, its specific application during labor, particularly for nulliparous women remains underexplored and back massage is practiced widely as standard care due to its physiological benefits by families and birth attendants in the region. 14. In the Omani context, where childbirth practices blend medical care with cultural and spiritual traditions, exploring such interventions is both relevant and necessary. There is a clear gap in the literature regarding the comparative effectiveness of Quran recitation versus back massage on labor outcomes, especially among nulliparous women who typically experience higher levels of labour pain and childbirth discomfort. Addressing this gap is essential for informing culturally sensitive, non-pharmacological pain-management approaches in maternity care. Objective The primary objective of this study is to evaluate the effectiveness of Quran recitation as a non-pharmacological intervention for reducing labor pain, discomfort during childbirth, and blood pressure among nulliparous women in Oman. Specific Objectives To assess the Impact of listening to the Holy Quran on labor pain intensity among nulliparous women. To examine the impact of Quran recitation on maternal blood pressure during labor. To evaluate whether Quran recitation enhances maternal childbirth comfort compared to standard care. To assess the overall effectiveness of the holy Quran recitation with back massage, a commonly used tactile relaxation technique. Materials and Methods Research Design A quasi-experimental (non-randomized) design was used to compare the effectiveness of Quran recitation versus back massage on labor pain, childbirth comfort, and blood pressure among nulliparous women undergoing normal vaginal delivery. The study was conducted at Khoula Hospital, Oman, which manages approximately 100 deliveries per month. Due to logistical constraints, participants were assigned sequentially to each group: the Quran group (experimental) was recruited during the first four months, and the back massage group in the following three months. This approach ensured standardized delivery of each intervention and minimized the risk of cross-contamination, especially given the auditory and tactile nature of both techniques. Although this method supported intervention fidelity, it may have introduced time-related confounding. To limit this, all participants were recruited from the same unit under stable clinical practices, with consistent data collection procedures. Sample and Sampling Procedure The sample size was calculated using G*Power version 3.1 based on Gallo et al. (2013), who reported mean pain scores of 52 mm (SD = 20) and 72 mm (SD = 15) in the intervention and control groups, respectively. With an effect size of 0.50, α = 0.05, and 80% power for a two-tailed t -test, a total sample size of 120 participants was required. 15 A convenience sampling technique was applied. Sixty nulliparous women admitted for labor were allocated to the Quran listening group over a four-month period, followed by another sixty women assigned to the back massage (control) group over the next three months. Key maternal characteristics such as age, gestational age, pain threshold, and prior exposure to pain management techniques were recorded to enhance internal validity. Inclusion and Exclusion Criteria Eligible participants were Omani nulliparous women with singleton term pregnancies (37–42 weeks) admitted for normal vaginal delivery in the active phase of labor (4–9 cm cervical dilatation) and who had attended regular antenatal follow-up. Women were excluded if they had medical or psychological disorders, obstetric complications, emergency cesarean section, non-Muslim status, conception via assisted reproductive technologies, or use of analgesic, opioid, or antipsychotic medications. Those with visual or hearing impairments or who received other pain management interventions before or during labor were also excluded. Data Collection Tools Five tools were used for data collection: Tool − 1. Developed by the researchers based on literature, it collected socio-demographic and lifestyle information, including age, education, residence, and frequency of Quran listening. Tool-2. Visual Analog Scale (VAS): The Visual Analogue Scale (VAS) was used to measure labor pain intensity. This tool consists of a 100-mm horizontal line, with endpoints labeled “no pain” (0 mm) and “worst imaginable pain” (100 mm). Participants were asked to place a mark on the line corresponding to the intensity of their perceived pain during uterine contractions. The distance from the “no pain” anchor to the participant’s mark was measured in millimeters, yielding a continuous pain score ranging from 0 to 100. The VAS is widely regarded as the gold standard for assessing subjective pain intensity due to its simplicity, sensitivity, and reproducibility in both clinical and research settings. 16–17 Tool 3 -. Pain Behavioral Observation Scale (BOS-3) : The Pain Behavioral Observation Scale (PBOS-3) was used to assess observable pain-related behaviors during labor. The scale evaluates five behavioral domains: vocalization, body movement, breathing control, facial expression, and communication. Each domain is rated on a 3-point Likert scale, where 1 indicates severe pain and 3 indicates minimal pain. cores range from 5 to 15 per domain. Each behavior is rated from 1 (severe pain) to 3 (minimal pain). Higher scores indicate improved coping and reduced observed pain behaviors. The PBOS-3 has demonstrated good internal consistency and inter-rater reliability in previous studies, with a reported reliability coefficient (Cronbach’s alpha) of 0.80. This tool provides an objective method for assessing nonverbal pain expressions and coping behaviors during labor. 18 Tool-4. Childbirth Comfort Questionnaire (CCQ): The Childbirth Comfort Questionnaire (CCQ), originally developed by Schuiling et al. (2004) and later validated in Turkish by Potur et al. (2015), is a validated instrument designed to assess maternal comfort during labor. It consists of nine items rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), yielding a total score between 9 and 45. Higher scores indicate greater perceived comfort. The questionnaire encompasses four dimensions of comfort: physical, psychospiritual, environmental, and sociocultural. In the present study, the internal consistency reliability of the CCQ was acceptable, with a Cronbach’s alpha coefficient of α = 0. 78.. 19–20 Tool-5. Physiological Measurement: Maternal blood pressure was measured using a calibrated Omron 705IT digital blood pressure monitor (model HEM-759-E). To ensure accuracy and consistency, the digital readings were routinely verified against a standard mercury sphygmomanometer. Blood pressure measurements were recorded at two distinct stages of active labor (4–6 cm and 7–9 cm cervical dilation), both before and after the intervention, under standardized conditions. Description of the Intervention. Written informed consent was obtained from all participants prior to enrollment. Upon admission to the labor room, baseline assessments of pain intensity, pain behaviors, and blood pressure were conducted. In the Quran recitation group, participants were evaluated for pain intensity using the Visual Analogue Scale (VAS) and for pain behaviors using the Pain Behavioral Observation Scale (PBOS-3) during three consecutive strong uterine contractions lasting 30 to 60 seconds each. Blood pressure was measured following each contraction. Participants then listened to recitations from two selected chapters of the Holy Quran Surah Maryam and Surah Al-Inshiqaq for 15 minutes each, in a calm and quiet environment. These chapters were chosen based on recommendations from Islamic scholars. 21 In the back massage group, baseline assessments were conducted using the same procedures. Participants then received a 30-minute back massage, administered according to Kimber’s protocol, 22 which involved 15 minutes of massage over the thoracic (T10) and sacral (S4) regions without the use of oil. The back massage was delivered by a trained researcher under the supervision of the obstetric care team. Post-intervention assessments of pain intensity, behavioral responses, and blood pressure were repeated during subsequent contractions using the same instruments in both groups. In addition, maternal comfort was assessed two hours postpartum using the Childbirth Comfort Questionnaire (CCQ). Due to the nature of the interventions, blinding of participants and data collectors was not feasible. However, to minimize observer bias, all behavioral assessments using the PBOS-3 were conducted by trained midwives following standardized scoring protocols. Observers were not involved in the clinical care of participants and were instructed to assess behaviors objectively based on pre-defined criteria. Ethical considerations Ethical approval for this study was obtained from the Research and Ethics Committee of Khoula Hospital, Oman, and the Research and Ethical Review and Approval Committee (RERAC) of the Ministry of Health, Oman (Approval Code: PRO 0092019043B). All participants received a full explanation of the study’s purpose, procedures, potential risks, and benefits prior to providing informed written consent. Participant confidentiality and data privacy were strictly maintained throughout the study. Written informed consent to participate was obtained from all participants prior to enrollment. Consent to publish was obtained from all participants as part of the informed consent process. Data analysis Data were analyzed using IBM SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means and standard deviations for continuous variables and frequencies with percentages for categorical variables, were used to summarize participant characteristics and baseline measures. To compare pre- and post-intervention outcomes within each group, paired sample t -tests were performed. Independent sample t -tests were used to compare post-intervention scores between the Quran recitation and control groups. Categorical variables were analyzed using the chi-square test. Analysis of variance (ANOVA) was used where appropriate to examine the association between maternal characteristics and childbirth comfort levels. Pearson’s correlation coefficient was applied to explore relationships between maternal expectations and childbirth comfort. A p -value of less than 0.05 was considered statistically significant for all analyses. Results Baseline characteristics A total of 120 nulliparous women participated in the study, with 60 in the Quran recitation group and 60 in the back massage group. As shown in Table 1, the groups were comparable across most sociodemographic and obstetric characteristics, including age, education, employment status, time of admission, type of delivery, and family structure ( p > 0.05 for all). However, a statistically significant difference was observed in gestational age ( p = 0.028), with more women in the control group delivering between 38–40 weeks. (Table-1) Labour Pain intensity Pain intensity, measured using the Visual Analogue Scale (VAS), showed a significant reduction in the Quran recitation group following the intervention. The mean VAS score decreased from 76.45 ± 8.20 to 58.32 ± 7.16, t (59) = 5.67, p < 0.001, with a 95% CI for the mean difference of [12.2, 22.4] and a large effect size (Cohen’s d = 1.0). In contrast, the back massage group showed a non-significant reduction in pain scores from 62.88 ± 8.44 to 61.10 ± 7.98, t (59) = 1.02, p = 0.312.. (Table 2). Pain Behavioral. As shown in Table 3 , the Quran recitation group demonstrated significant improvements across all five domains of pain-related behaviors following the intervention. Mean scores for vocalization increased from 26.83 ± 3.88 to 28.31 ± 3.52 ( t (59) = 2.08, p = 0.003, 95% CI [0.51, 2.47], Cohen’s d = 0.36), while body movement improved from 32.31 ± 3.52 to 33.60 ± 3.22 ( t (59) = 2.19, p = 0.045, 95% CI [0.03, 2.57], d = 0.37). Breathing control showed a substantial improvement, with scores increasing from 27.66 ± 3.90 to 31.70 ± 3.02 ( t (59) = 4.04, p < 0.001, 95% CI [2.09, 5.82], d = 0.78). Facial expression scores increased from 26.95 ± 3.81 to 29.60 ± 3.01 ( t (59) = 2.45, p = 0.005, 95% CI [0.83, 4.53], d = 0.49), and communication improved from 27.77 ± 3.90 to 31.60 ± 3.02 ( t (59) = 4.02, p < 0.001, 95% CI [2.01, 5.38], d = 0.77). These results suggest that Quran recitation positively influenced both behavioral pain responses and maternal coping mechanisms during labor. In contrast, the control group demonstrated statistically significant improvements in only two domains. Body movement scores decreased from 32.88 ± 3.67 to 30.61 ± 3.10 ( t (59) = 5.86, p < 0.001), and communication scores increased from 27.73 ± 3.93 to 31.70 ± 3.02 ( t (59) = 4.06, p 0.05). The Childbirth Comfort As presented in Table 4 , there were no statistically significant differences between the Quran recitation and back massage groups in total comfort scores or any subdomains during the early active phase of labor (4–5 cm cervical dilation) ( p > 0.05). However, following the intervention, during the advanced active phase of labor (6–9 cm cervical dilation), the Quran recitation group reported significantly higher total comfort scores compared to the control group (34.13 ± 3.47 vs. 30.05 ± 3.77, p = 0.002). Post-intervention comparisons between groups revealed significantly higher scores in several specific comfort subdomains for the Quran recitation group. Sociocultural comfort was higher in the intervention group (22.00 ± 2.21) compared to the control group (19.83 ± 2.37), with a p -value of 0.002. Similarly, the relief subdomain showed a significant difference, with mean scores of 22.60 ± 2.21 for the intervention group and 18.93 ± 2.37 for the control group ( p = 0.002). Transcendence scores were also significantly higher in the Quran group (12.03 ± 1.67) than in the control group (11.23 ± 1.43), ( p = 0.025). No statistically significant differences were found between the groups in the physical, psychospiritual, or environmental comfort subdomains ( p > 0.05). These results indicate that Quran recitation was more effective than back massage in improving overall childbirth comfort, particularly in dimensions related to sociocultural support, perceived relief, and spiritual transcendence. Blood pressure Blood pressure was assessed at two stages of cervical dilation (4–6 cm and 7–9 cm) before and after the intervention. In the Quran recitation group, both systolic and diastolic pressures decreased significantly following the intervention. At 4–6 cm dilation, systolic pressure declined from 115.4 ± 11.7 mmHg to 100.8 ± 8.99 mmHg, and diastolic pressure decreased from 88.31 ± 6.45 mmHg to 77.92 ± 9.83 mmHg (p < 0.001 for both). At 7–9 cm dilation, systolic pressure dropped from 135.75 ± 8.51 mmHg to 127.69 ± 7.63 mmHg, and diastolic pressure from 90.00 ± 4.73 mmHg to 80.66 ± 6.76 mmHg (p < 0.001). These findings are visualized in Figure 1 , which illustrates the significant hemodynamic stabilizing effect of Quran recitation during active labor. Multivariate linear regression analyses were conducted to assess the effect of the intervention while adjusting for gestational age, time of admission, and prior Quran exposure. After controlling for these covariates: Quran recitation remained a significant predictor of lower post-intervention pain intensity (β = –0.61, p < 0.001). It was also significantly associated with higher total childbirth comfort scores (β = 0.48, p = 0.003), particularly in the sociocultural and relief subdomains. Systolic and diastolic blood pressure reductions remained significant (β = –0.53 and –0.49, respectively; both p 0.05), though it showed a mild association with systolic blood pressure (p = 0.048). These results confirm that the observed benefits of Quran recitation were not confounded by gestational age or other covariates. (Table-5) Discussion This study aimed to compare the effects of Quran listening and back massage on labor pain, pain behaviors, childbirth comfort, and blood pressure among parturient women. The findings revealed that listening to the Quran was significantly more effective than back massage in reducing pain intensity, enhancing pain-coping behaviors, increasing childbirth comfort, and stabilizing maternal blood pressure during labor. The baseline sociodemographic and obstetric characteristics of the two groups were largely comparable, with the exception of gestational age, which differed significantly ( p = 0.028); more women in the control group delivered between 38–40 weeks. This variation may influence labor experiences such as pain perception or progression and should be acknowledged as a potential confounding factor. Nevertheless, the similarity across most baseline variables supports the internal validity of the study, strengthening the attribution of post-intervention differences to the effects of the interventions. The consistently significant improvements observed in the Quran recitation group across multiple independent domains—including pain intensity, behavioral responses, comfort levels, and physiological parameters—further reinforce the robustness of the findings. Particularly, large effect sizes in pain reduction (Cohen’s d = 1.0), blood pressure regulation ( d = 1.00–1.42), and comfort subdomains such as relief ( d = 1.59) suggest that the intervention’s effectiveness is unlikely to be solely explained by differences in gestational age. Future studies should consider adjusting for gestational age using stratified analysis or multivariate modeling to further isolate the effect of the intervention. The significant reduction in VAS scores among mothers who listened to the Quran indicates that Quran recitation is an effective non-pharmacological method for alleviating labor pain. This is consistent with previous research suggesting that exposure to Quranic recitation promotes relaxation, reduces anxiety, and modulates pain perception through both auditory and spiritual pathways (e.g., activation of the parasympathetic nervous system and reduction in cortisol levels). In contrast, the control group receiving back massage exhibited minimal, non-significant pain reduction, indicating that while physical touch may offer some relief, it is less effective than spiritually oriented auditory stimulation in altering pain perception. These findings align with earlier studies showing that listening to spiritual or religious recitations enhances endorphin release and reduces pain perception during labor. 23–25 The Quran listening group also demonstrated significant improvements across all five domains of pain-related behaviors—vocalization, body movement, breathing control, facial expression, and communication—indicating better coping and self-regulation during labor. This suggests that the intervention may foster psychological relaxation and strengthen spiritual resilience, enabling mothers to endure contractions with improved breathing patterns, emotional control, and verbal communication. By comparison, the control group showed improvements only in body movement and communication, reflecting the limited impact of massage on deeper cognitive and emotional coping mechanisms. These observations are consistent with prior studies indicating that religious interventions enhance emotional regulation and coping during childbirth, resulting in more positive labor experiences 26 – 27 . In terms of childbirth comfort, Quran listening significantly improved total comfort scores and specific subdomains, including sociocultural comfort, relief, and transcendence. This suggests that the intervention not only reduced physical pain but also enhanced emotional, spiritual, and social well-being. Listening to the Quran likely evoked a sense of divine presence and reassurance, helping mothers feel spiritually connected, emotionally supported, and psychologically safe. In contrast, back massage, while offering some physical relief, did not significantly affect overall comfort—particularly in the spiritual or transcendent domains. These findings are supported by studies emphasizing the spiritual dimension of maternal comfort, in which faith-based auditory interventions foster trust, relaxation, and a sense of optimism during labor. 28–29 Significant reductions in both systolic and diastolic blood pressure were observed in the Quran listening group, indicating a strong hemodynamic stabilizing effect. This physiological response is characteristic of a relaxation state, likely mediated by reduced sympathetic arousal and enhanced parasympathetic activity. In contrast, the control group experienced no significant changes in blood pressure, further highlighting the superior physiological impact of Quran recitation. Similar effects have been documented in previous studies, where listening to Quranic verses reduced blood pressure, heart rate, and stress hormone levels in pregnant women and during various medical procedures 30 – 32 Collectively, these findings suggest that Quran listening is a powerful, non-invasive, and culturally appropriate intervention that addresses the physical, psychological, and spiritual dimensions of maternal well-being during labor. It effectively reduces pain, enhances coping behaviors, promotes comfort, and stabilizes physiological parameters—without adverse effects making it a promising adjunct to maternity care, particularly in culturally aligned settings. Limitations and Recommendations This study has several limitations. The quasi-experimental, non-randomized design with convenience sampling may have introduced selection bias and limits generalizability. Sequential recruitment over different months may have caused time-related confounding, despite consistent care protocols. The lack of blinding and use of observer-rated behavioral tools could also introduce bias. Future studies should use randomized controlled trials with parallel groups, blinded assessors, and broader sampling to improve validity. A significant difference in gestational age was found between groups (p = 0.028), with more control participants delivering at 38–40 weeks. Although regression analysis adjusted for this variable, future research should use subgroup analyses by gestational age to ensure the effects are independent of maturity at delivery. Conclusion This study demonstrates that listening to Quran recitation is significantly more effective than back massage in reducing labor pain, enhancing pain-coping behaviors, improving maternal comfort, and stabilizing blood pressure among nulliparous women. As a non-pharmacological, culturally appropriate, and spiritually meaningful intervention, Quran recitation offers a holistic approach to labor support that addresses both physical and emotional dimensions of childbirth. Its ease of implementation, safety profile, and cultural acceptability make it a valuable adjunct to routine obstetric care, particularly in Islamic settings. Given the limitations of this quasi-experimental design, future research should utilize randomized controlled trials to confirm these findings and explore underlying neurophysiological mechanisms. Additional comparisons with other auditory and relaxation-based interventions could further delineate the unique contributions of spiritual content to maternal outcomes. Integration of Quran recitation into maternity care protocols has the potential to enhance childbirth experiences, promote maternal well-being, and support personalized, respectful labor care. Declarations Acknowledgments: The authors would like to thank the staff of Khoula Hospital, Oman, and the Ministry of Health for their support and cooperation. Special thanks are extended to the participating mothers and the midwifery team for their valuable contributions to this study. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest: The authors declare no conflict of interest. Ethics approval and consent to participate This study was reviewed and approved by the Research and Ethics Committee of Khoula Hospital, Oman, and the Research and Ethical Review and Approval Committee (RERAC) of the Ministry of Health, Oman (Approval Code: PRO 0092019043B). Informed written consent was obtained from all participants prior to inclusion in the study. Consent for publication Not applicable. References McKelvin G, Thomson G, Downe S. 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Relationship between spiritual intelligence with happiness and fear of childbirth in Iranian pregnant women. Iranian journal of nursing and midwifery research. 2018 Jan 1;23(1):45-50. Simonovich SD, Quad N, Kanji Z, Tabb KM. Faith practices reduce perinatal anxiety and depression in Muslim women: a mixed-methods scoping review. Frontiers in psychiatry. 2022 May 24; 13:826769. Mansouri A, Vahed AS, Sabouri AR, Lakzaei H, Arbabisarjou A. Investigating Aid Effect of Holy Quran Sound on Blood Pressure, Pulse, Respiration and O. Int J Sci Study. 2017;5(7). Ningsih E, Islamiyati I, Riyanto R, Gumelar R. The Impact of the Combination Therapy of Listening to the Holy Quran and Progressive Muscle Relaxation on Blood Pressure Reduction in Women of Reproductive Age with Hypertension: A Randomized Controlled Trial Study. Jurnal Kesehatan Metro Sai Wawai. 2024 Jun 28;17(1):28-36. Meiranny A, Rahmawati A, Arisanti AZ. Is Prenatal Exercise with Prayer Movement Affecting Anxiety Level and Blood Pressure in Third Trimester?. Jurnal Kesehatan Masyarakat. 2022 Mar 17;17(3):329-41. Tables Table-1 Sociodemographic and Obstetric Characteristics of Participants Variables Intervention group (n=60 ) Control group (n= 60) χ² test p - value n % n % Age (years) 4.68 0.197 20–24 15 25% 20 33.3% 25–29 26 43.3% 30 50% 30–34 10 16.7% 7 11.7% ≥35 9 15% 3 5% Mother’s education level 4.43 0.109 Up to 12 th grade 20 33.3% 24 40.0% Graduate 25 41.7% 38 63.3% Postgraduate and above 15 25.0% 8 13.3% Mother’s employment status 1.21 0.270 Employed 34 56.7% 28 46.7% Not employed 26 43.3% 32 53.3% Gestational age (weeks) 4.80 0.028* 36-37 weeks 28 46.7% 24 40% 38-40weeks 32 53.3% 36 60% >40 weeks 0 0 Time of admission to delivery room 0.24 0.620 Latent phase 49 81.7% 51 85.0% Active phase 11 18.3% 9 15.0% Type of delivery 1.34 0.250 Vaginal birth without episiotomy 38 63.3% 35 58.3% Vaginal birth with episiotomy 22 36.7% 25 41.7% Family structure 0.36 0.550 Nuclear 50 83.3% 52 86.7% Extended 10 16.7% 8 13.3% Note: Values are expressed as frequencies and percentages. χ² test was applied to compare groups. *p* < 0.05 was considered statistically significant. *Statistically significant difference at *p* < 0.05. Table 2. Comparison of Visual Analogue Scale (VAS) scores for labor pain before and after the intervention (N = 120) Group Before Intervention (Mean ± SD) After Intervention (Mean ± SD) t p-value Quran Recitation 76.45 ± 8.20 58.32 ± 7.16 5.67 0.001* Back Massage (Control) 62.88 ± 8.44 61.10 ± 7.98 1.02 0.312 Note: Data are expressed as mean ± standard deviation. VAS = Visual Analogue Scale (0 = no pain, 100 = worst imaginable pain). Paired t-test was applied to compare pre- and post-intervention scores. *Statistically significant at p < 0.05. Table- 3. Pain Behavioral Observation Scale (PBOS-3) Scores Before and After the Intervention (with CI and Effect Size) Domain Group Pre (Mean ± SD) Post (Mean ± SD) t (df) p-value 95% CI Cohen’s d Vocalization Quran 26.83 ± 3.88 28.31 ± 3.52 2.08 (59) 0.003* [0.50, 2.46] 0.36 Control 27.89 ± 3.80 28.40 ± 3.49 1.25 (59) 0.25 Body Movement Quran 32.31 ± 3.52 33.60 ± 3.22 2.19 (59) 0.045* [0.03, 2.57] 0.37 Control 32.88 ± 3.67 30.61 ± 3.10 5.86 (59) <0.001* Breathing Control Quran 27.66 ± 3.90 31.70 ± 3.02 4.04 (59) <0.001* [2.09, 5.82] 0.78 Control 34.45 ± 1.81 35.45 ± 4.32 1.56 (59) 0.31 Facial Expression Quran 26.95 ± 3.81 29.60 ± 3.01 2.45 (59) 0.005* [0.83, 4.53] 0.49 Control 26.86 ± 3.88 25.89 ± 3.88 1.30 (59) 0.29 Communication Quran 27.77 ± 3.90 31.60 ± 3.02 4.02 (59) <0.001* [2.01, 5.38] 0.77 Control 27.73 ± 3.93 31.70 ± 3.02 4.06 (59) <0.001* Note- PBOS-3 scores range from 5 to 15 per domain. Each domain is rated on a 3-point scale (1 =severe pain,3 =minimal pain). Higher scores indicate improved behavioral coping and reduced pain expression. A decrease in score reflects worsening pain behavior. Statistical significance is based on paired t-tests within each group. Table-4 Comparison of Childbirth Comfort Questionnaire (CCQ) Scores After Intervention Between Groups (with CI and Effect Size) Comfort Domain Quran Group(Mean ± SD) Control Group(Mean ± SD) p-value 95% CI (Between-group) Cohen’s d Total Comfort Score 34.13 ± 3.47 30.05 ± 3.77 0.002* [1.47, 6.74] 1.13 Physical Comfort 13.01 ± 1.85 12.20 ± 2.17 0.0678 [–0.06, 1.65] 0.41 Psychospiritual Comfort 5.46 ± 1.30 5.00 ± 2.11 0.625 [–0.74, 1.65] 0.26 Environmental Comfort 12.43 ± 1.59 11.63 ± 1.65 0.085 [–0.12, 1.68] 0.49 Sociocultural Comfort 22.00 ± 2.21 19.83 ± 2.37 0.002* [0.80, 3.55] 0.94 Relief 22.60 ± 2.21 18.93 ± 2.37 0.002* [1.55, 5.04] 1.59 Transcendence 12.03 ± 1.67 11.23 ± 1.43 0.025* [0.10, 1.50] 0.51 Table-5. Multivariate Linear Regression Analyses Adjusting for Gestational Age, Time of Admission, and Prior Quran Exposure Outcome Variable Predictor (Quran Recitation vs. Back Massage) Standardized β Coefficient p-value Post-intervention pain intensity (VAS) Quran recitation –0.61 < 0.001 Childbirth comfort (total CCQ score) Quran recitation 0.48 0.003 CCQ Subdomains – Physical comfort Quran recitation 0.23 0.078 – Psychospiritual comfort Quran recitation 0.29 0.056 – Environmental comfort Quran recitation 0.18 0.104 – Sociocultural comfort Quran recitation 0.51 0.004 – Relief Quran recitation 0.55 0.002 – Transcendence Quran recitation 0.42 0.018 Systolic blood pressure Quran recitation –0.53 < 0.001 Diastolic blood pressure Quran recitation –0.49 < 0.001 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8666369","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588713089,"identity":"0c8ea51c-4030-4f21-92aa-ede1e0503d00","order_by":0,"name":"Widad Al Kharusi","email":"","orcid":"","institution":"Faculty in Midwifery Program, Higher Institute of Health Specialties, Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Widad","middleName":"Al","lastName":"Kharusi","suffix":""},{"id":588713091,"identity":"3851f562-5ec9-4b73-b9e9-89a92712be57","order_by":1,"name":"Sophia Cyril Vincent","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYBAC+QYGNoYEEIuZufEBRCwBvxaDA3AtjM0GxGlhAGqBAMY2CeK0sPcee/Cgxi5xeztjW+WPssMM/Ow5Bgwfc3Brke85l26QcCw5cc5hxrbbPOcOM0j2vDFgnLkNjzU3cswkEtgOJM5gBmphbDvMYHAjx4CZl6CWfxAthT+BWuyJ0pLYBtHCwAuyRYKAFoMz59IkEvuSjYFamqV5zqXzSJx5VnAQn1/k23uPSf74Zic7g//wwY8/yqzl+NuTNz74iM9hDDxg0rEBTLFBuAfwaYBpsWeAahkFo2AUjIJRgAEA2zNRncjNzR4AAAAASUVORK5CYII=","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":true,"prefix":"","firstName":"Sophia","middleName":"Cyril","lastName":"Vincent","suffix":""},{"id":588713092,"identity":"68d46a48-db33-4e08-bfe4-44dab6b57fde","order_by":2,"name":"Fatima Al Muqbali","email":"","orcid":"","institution":"Khoula Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"Al","lastName":"Muqbali","suffix":""},{"id":588713093,"identity":"5e33ade7-b807-45f2-b981-ff575c35b5fa","order_by":3,"name":"Aysha Al Hashmi Al Hashmi","email":"","orcid":"","institution":"Oman college of health sciences . North Sharqiya","correspondingAuthor":false,"prefix":"","firstName":"Aysha","middleName":"Al Hashmi Al","lastName":"Hashmi","suffix":""}],"badges":[],"createdAt":"2026-01-22 07:09:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8666369/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8666369/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102597399,"identity":"31fd17a6-a9c3-4012-9367-4065c92f1eb4","added_by":"auto","created_at":"2026-02-13 12:25:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":195360,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Fig1BP.png","url":"https://assets-eu.researchsquare.com/files/rs-8666369/v1/2f79642c86c943c8f6a0da9d.png"},{"id":102597837,"identity":"57d002c6-6fcd-4d7e-ac7f-231865bf191e","added_by":"auto","created_at":"2026-02-13 12:26:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1348131,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8666369/v1/f6663458-5d7b-41ad-9067-f29c30aced1d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of Quran Recitation on Labor Pain, Maternal Comfort, and Blood Pressure: A Quasi-Experimental Study in Nulliparous Women\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLabor pain is one of the most intense and distressing forms of pain experienced by women, and it significantly shapes their perceptions of childbirth, future reproductive choices, and overall maternal satisfaction. The pain arises from the stretching and dilation of the cervix, vagina, and perineum, along with strong and rhythmic uterine contractions.\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e Anxiety, which commonly accompanies labor, intensifies the perception of pain and can adversely affect the course of childbirth.\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e Elevated stress hormones such as adrenaline and cortisol triggered by severe pain and fear of labour, reduce uterine efficiency, prolong labor, and increase the risk of maternal and neonatal complications.\u003cb\u003e\u0026sup3;\u003c/b\u003e Prolonged labor can further contribute to maternal exhaustion, infection, physical strain, neurological stress, and sleep disturbances, highlighting the importance of effective pain-management strategies. \u003csup\u003e\u003cb\u003e4\u0026ndash;5\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUncontrolled labor pain also carries long-term psychological consequences, including traumatic birth experiences, heightened childbirth discomfort, and increased risk of postpartum depression. Globally, nearly 75\u0026ndash;85% of expectant mothers report significant anxiety in the period leading up to labor, underscoring the need for interventions that address both physical pain and emotional distress. \u003csup\u003e\u003cb\u003e6\u003c/b\u003e\u003c/sup\u003e Inadequate pain relief has additionally been associated with increased cesarean section (CS) rates is a concern in Oman, where CS rates rose from 15.72% in 2009 to 21.7% in 2020 which is drastically increased to 26% in 2024.\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e These trends reinforce the need for safe, acceptable, and effective pain-management strategies for women, particularly primi gravida who often experience heightened labour pain and childbirth comfort.\u003c/p\u003e \u003cp\u003eWhile pharmacological approaches such as epidural analgesia remain the gold standard for labor pain relief, they can be associated with side effects such as hypotension, prolonged labor, and increased rates of instrumental delivery.\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e This has encouraged greater interest in non-pharmacological interventions, which are valued for their safety, minimal invasiveness, and ability to promote maternal autonomy and relaxation. Auditory techniques such as music therapy have been shown to reduce anxiety, stabilize blood pressure, and increase pain thresholds by promoting psychological calmness.\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e Similarly, tactile methods like massage facilitate circulation, stimulate endorphin release, and relieve muscle tension, resulting in reduced pain intensity and improved maternal comfort. \u003csup\u003e\u003cb\u003e10\u003c/b\u003e\u003c/sup\u003e Techniques such as Kimber\u0026rsquo;s massage and oil-based massage have demonstrated significant reductions in labor pain and decreased need for pharmacological analgesia.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn culturally rooted contexts such as Oman, spiritual auditory interventions offer additional relevance. Quran recitation, characterized by rhythmic and melodic verses, has been shown to promote relaxation, reduce pain perception, lower blood pressure, and enhance maternal satisfaction in various clinical settings.\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e However, despite its cultural and spiritual significance, its specific application during labor, particularly for nulliparous women remains underexplored and back massage is practiced widely as standard care due to its physiological benefits by families and birth attendants in the region. \u003csup\u003e\u003cb\u003e14.\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e In the Omani context, where childbirth practices blend medical care with cultural and spiritual traditions, exploring such interventions is both relevant and necessary. There is a clear gap in the literature regarding the comparative effectiveness of Quran recitation versus back massage on labor outcomes, especially among nulliparous women who typically experience higher levels of labour pain and childbirth discomfort. Addressing this gap is essential for informing culturally sensitive, non-pharmacological pain-management approaches in maternity care.\u003c/p\u003e\n\u003ch3\u003eObjective\u003c/h3\u003e\n\u003cp\u003eThe primary objective of this study is to evaluate the effectiveness of Quran recitation as a non-pharmacological intervention for reducing labor pain, discomfort during childbirth, and blood pressure among nulliparous women in Oman.\u003c/p\u003e \u003cp\u003eSpecific Objectives\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess the Impact of listening to the Holy Quran on labor pain intensity among nulliparous women.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo examine the impact of Quran recitation on maternal blood pressure during labor.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo evaluate whether Quran recitation enhances maternal childbirth comfort compared to standard care.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess the overall effectiveness of the holy Quran recitation with back massage, a commonly used tactile relaxation technique.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eResearch Design\u003c/p\u003e\n\u003cp\u003eA quasi-experimental (non-randomized) design was used to compare the effectiveness of Quran recitation versus back massage on labor pain, childbirth comfort, and blood pressure among nulliparous women undergoing normal vaginal delivery. The study was conducted at Khoula Hospital, Oman, which manages approximately 100 deliveries per month.\u003c/p\u003e\n\u003cp\u003eDue to logistical constraints, participants were assigned sequentially to each group: the Quran group (experimental) was recruited during the first four months, and the back massage group in the following three months. This approach ensured standardized delivery of each intervention and minimized the risk of cross-contamination, especially given the auditory and tactile nature of both techniques.\u003c/p\u003e\n\u003cp\u003eAlthough this method supported intervention fidelity, it may have introduced time-related confounding. To limit this, all participants were recruited from the same unit under stable clinical practices, with consistent data collection procedures.\u003c/p\u003e\n\u003cp\u003eSample and Sampling Procedure\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using G*Power version 3.1 based on Gallo et al. (2013), who reported mean pain scores of 52 mm (SD\u0026thinsp;=\u0026thinsp;20) and 72 mm (SD\u0026thinsp;=\u0026thinsp;15) in the intervention and control groups, respectively. With an effect size of 0.50, \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05, and 80% power for a two-tailed \u003cem\u003et\u003c/em\u003e-test, a total sample size of 120 participants was required. \u003csup\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eA convenience sampling technique was applied. Sixty nulliparous women admitted for labor were allocated to the Quran listening group over a four-month period, followed by another sixty women assigned to the back massage (control) group over the next three months. Key maternal characteristics such as age, gestational age, pain threshold, and prior exposure to pain management techniques were recorded to enhance internal validity.\u003c/p\u003e\n\u003cp\u003eInclusion and Exclusion Criteria\u003c/p\u003e\n\u003cp\u003eEligible participants were Omani nulliparous women with singleton term pregnancies (37\u0026ndash;42 weeks) admitted for normal vaginal delivery in the active phase of labor (4\u0026ndash;9 cm cervical dilatation) and who had attended regular antenatal follow-up.\u003c/p\u003e\n\u003cp\u003eWomen were excluded if they had medical or psychological disorders, obstetric complications, emergency cesarean section, non-Muslim status, conception via assisted reproductive technologies, or use of analgesic, opioid, or antipsychotic medications. Those with visual or hearing impairments or who received other pain management interventions before or during labor were also excluded.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eFive tools were used for data collection:\u003c/p\u003e\n\u003cp\u003eTool\u0026thinsp;\u0026minus;\u0026thinsp;1. Developed by the researchers based on literature, it collected socio-demographic and lifestyle information, including age, education, residence, and frequency of Quran listening.\u003c/p\u003e\n\u003ch3\u003eTool-2. Visual Analog Scale (VAS):\u003c/h3\u003e\n\u003cp\u003eThe Visual Analogue Scale (VAS) was used to measure labor pain intensity. This tool consists of a 100-mm horizontal line, with endpoints labeled \u0026ldquo;no pain\u0026rdquo; (0 mm) and \u0026ldquo;worst imaginable pain\u0026rdquo; (100 mm). Participants were asked to place a mark on the line corresponding to the intensity of their perceived pain during uterine contractions. The distance from the \u0026ldquo;no pain\u0026rdquo; anchor to the participant\u0026rsquo;s mark was measured in millimeters, yielding a continuous pain score ranging from 0 to 100. The VAS is widely regarded as the gold standard for assessing subjective pain intensity due to its simplicity, sensitivity, and reproducibility in both clinical and research settings. \u003csup\u003e\u003cstrong\u003e16\u0026ndash;17\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTool 3\u003c/strong\u003e-. \u003cstrong\u003ePain Behavioral Observation Scale (BOS-3)\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe Pain Behavioral Observation Scale (PBOS-3) was used to assess observable pain-related behaviors during labor. The scale evaluates five behavioral domains: vocalization, body movement, breathing control, facial expression, and communication. Each domain is rated on a 3-point Likert scale, where 1 indicates severe pain and 3 indicates minimal pain. cores range from 5 to 15 per domain. Each behavior is rated from 1 (severe pain) to 3 (minimal pain). Higher scores indicate improved coping and reduced observed pain behaviors.\u003c/p\u003e\n\u003cp\u003eThe PBOS-3 has demonstrated good internal consistency and inter-rater reliability in previous studies, with a reported reliability coefficient (Cronbach\u0026rsquo;s alpha) of 0.80. This tool provides an objective method for assessing nonverbal pain expressions and coping behaviors during labor. \u003csup\u003e\u003cstrong\u003e18\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eTool-4. Childbirth Comfort Questionnaire (CCQ):\u003c/h3\u003e\n\u003cp\u003eThe Childbirth Comfort Questionnaire (CCQ), originally developed by Schuiling et al. (2004) and later validated in Turkish by Potur et al. (2015), is a validated instrument designed to assess maternal comfort during labor. It consists of nine items rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), yielding a total score between 9 and 45. Higher scores indicate greater perceived comfort. The questionnaire encompasses four dimensions of comfort: physical, psychospiritual, environmental, and sociocultural. In the present study, the internal consistency reliability of the CCQ was acceptable, with a Cronbach\u0026rsquo;s alpha coefficient of \u0026alpha;\u0026thinsp;=\u0026thinsp;0. 78.. \u003csup\u003e\u003cstrong\u003e19\u0026ndash;20\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eTool-5. Physiological Measurement:\u003c/h3\u003e\n\u003cp\u003eMaternal blood pressure was measured using a calibrated \u003cstrong\u003eOmron 705IT digital blood pressure monitor\u003c/strong\u003e (model HEM-759-E). To ensure accuracy and consistency, the digital readings were routinely verified against a standard mercury sphygmomanometer. Blood pressure measurements were recorded at two distinct stages of active labor (4\u0026ndash;6 cm and 7\u0026ndash;9 cm cervical dilation), both before and after the intervention, under standardized conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescription of the Intervention.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants prior to enrollment. Upon admission to the labor room, baseline assessments of pain intensity, pain behaviors, and blood pressure were conducted.\u003c/p\u003e\n\u003cp\u003eIn the Quran recitation group, participants were evaluated for pain intensity using the Visual Analogue Scale (VAS) and for pain behaviors using the Pain Behavioral Observation Scale (PBOS-3) during three consecutive strong uterine contractions lasting 30 to 60 seconds each. Blood pressure was measured following each contraction. Participants then listened to recitations from two selected chapters of the Holy Quran Surah Maryam and Surah Al-Inshiqaq for 15 minutes each, in a calm and quiet environment. These chapters were chosen based on recommendations from Islamic scholars. \u003csup\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn the back massage group, baseline assessments were conducted using the same procedures. Participants then received a 30-minute back massage, administered according to Kimber\u0026rsquo;s protocol, \u003csup\u003e\u003cstrong\u003e22\u003c/strong\u003e\u003c/sup\u003e which involved 15 minutes of massage over the thoracic (T10) and sacral (S4) regions without the use of oil. The back massage was delivered by a trained researcher under the supervision of the obstetric care team.\u003c/p\u003e\n\u003cp\u003ePost-intervention assessments of pain intensity, behavioral responses, and blood pressure were repeated during subsequent contractions using the same instruments in both groups. In addition, maternal comfort was assessed two hours postpartum using the Childbirth Comfort Questionnaire (CCQ).\u003c/p\u003e\n\u003cp\u003eDue to the nature of the interventions, blinding of participants and data collectors was not feasible. However, to minimize observer bias, all behavioral assessments using the PBOS-3 were conducted by trained midwives following standardized scoring protocols. Observers were not involved in the clinical care of participants and were instructed to assess behaviors objectively based on pre-defined criteria.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eEthical considerations\u003c/h2\u003e\n \u003cp\u003eEthical approval for this study was obtained from the Research and Ethics Committee of Khoula Hospital, Oman, and the Research and Ethical Review and Approval Committee (RERAC) of the Ministry of Health, Oman (Approval Code: PRO 0092019043B). All participants received a full explanation of the study\u0026rsquo;s purpose, procedures, potential risks, and benefits prior to providing informed written consent. Participant confidentiality and data privacy were strictly maintained throughout the study.\u003c/p\u003e\n \u003cp\u003eWritten informed consent to participate was obtained from all participants prior to enrollment. Consent to publish was obtained from all participants as part of the informed consent process.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eData were analyzed using IBM SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means and standard deviations for continuous variables and frequencies with percentages for categorical variables, were used to summarize participant characteristics and baseline measures. To compare pre- and post-intervention outcomes within each group, paired sample \u003cem\u003et\u003c/em\u003e-tests were performed. Independent sample \u003cem\u003et\u003c/em\u003e-tests were used to compare post-intervention scores between the Quran recitation and control groups. Categorical variables were analyzed using the chi-square test. Analysis of variance (ANOVA) was used where appropriate to examine the association between maternal characteristics and childbirth comfort levels. Pearson\u0026rsquo;s correlation coefficient was applied to explore relationships between maternal expectations and childbirth comfort. A \u003cem\u003ep\u003c/em\u003e-value of less than 0.05 was considered statistically significant for all analyses.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 120 nulliparous women participated in the study, with 60 in the Quran recitation group and 60 in the back massage group. As shown in Table 1, the groups were comparable across most sociodemographic and obstetric characteristics, including age, education, employment status, time of admission, type of delivery, and family structure (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05 for all). However, a statistically significant difference was observed in gestational age (\u003cem\u003ep\u003c/em\u003e = 0.028), with more women in the control group delivering between 38–40 weeks. \u003cstrong\u003e(Table-1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLabour Pain intensity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePain intensity, measured using the Visual Analogue Scale (VAS), showed a significant reduction in the Quran recitation group following the intervention. The mean VAS score decreased from 76.45 ± 8.20 to 58.32 ± 7.16, \u003cem\u003et\u003c/em\u003e(59) = 5.67, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, with a 95% CI for the mean difference of [12.2, 22.4] and a large effect size (Cohen’s\u0026nbsp;\u003cem\u003ed\u003c/em\u003e = 1.0).\u003cbr\u003eIn contrast, the back massage group showed a non-significant reduction in pain scores from 62.88 ± 8.44 to 61.10 ± 7.98, \u003cem\u003et\u003c/em\u003e(59) = 1.02, \u003cem\u003ep\u003c/em\u003e = 0.312.. \u003cstrong\u003e(Table 2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePain Behavioral.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in \u003cstrong\u003eTable 3\u003c/strong\u003e, the Quran recitation group demonstrated significant improvements across all five domains of pain-related behaviors following the intervention. Mean scores for vocalization increased from 26.83 ± 3.88 to 28.31 ± 3.52 (\u003cem\u003et\u003c/em\u003e(59) = 2.08, \u003cem\u003ep\u003c/em\u003e = 0.003, 95% CI [0.51, 2.47], Cohen’s \u003cem\u003ed\u003c/em\u003e = 0.36), while body movement improved from 32.31 ± 3.52 to 33.60 ± 3.22 (\u003cem\u003et\u003c/em\u003e(59) = 2.19, \u003cem\u003ep\u003c/em\u003e = 0.045, 95% CI [0.03, 2.57], \u003cem\u003ed\u003c/em\u003e = 0.37). Breathing control showed a substantial improvement, with scores increasing from 27.66 ± 3.90 to 31.70 ± 3.02 (\u003cem\u003et\u003c/em\u003e(59) = 4.04, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 95% CI [2.09, 5.82], \u003cem\u003ed\u003c/em\u003e = 0.78). Facial expression scores increased from 26.95 ± 3.81 to 29.60 ± 3.01 (\u003cem\u003et\u003c/em\u003e(59) = 2.45, \u003cem\u003ep\u003c/em\u003e = 0.005, 95% CI [0.83, 4.53], \u003cem\u003ed\u003c/em\u003e = 0.49), and communication improved from 27.77 ± 3.90 to 31.60 ± 3.02 (\u003cem\u003et\u003c/em\u003e(59) = 4.02, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 95% CI [2.01, 5.38], \u003cem\u003ed\u003c/em\u003e = 0.77). These results suggest that Quran recitation positively influenced both behavioral pain responses and maternal coping mechanisms during labor.\u003c/p\u003e\n\u003cp\u003eIn contrast, the control group demonstrated statistically significant improvements in only two domains. Body movement scores decreased from 32.88 ± 3.67 to 30.61 ± 3.10 (\u003cem\u003et\u003c/em\u003e(59) = 5.86, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), and communication scores increased from 27.73 ± 3.93 to 31.70 ± 3.02 (\u003cem\u003et\u003c/em\u003e(59) = 4.06, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). No significant changes were observed in vocalization, breathing control, or facial expression scores within the control group (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Childbirth Comfort\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs presented in \u003cstrong\u003eTable 4\u003c/strong\u003e, there were no statistically significant differences between the Quran recitation and back massage groups in total comfort scores or any subdomains during the early active phase of labor (4–5 cm cervical dilation) (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05). However, following the intervention, during the advanced active phase of labor (6–9 cm cervical dilation), the Quran recitation group reported significantly higher total comfort scores compared to the control group (34.13 ± 3.47 vs. 30.05 ± 3.77, \u003cem\u003ep\u003c/em\u003e = 0.002).\u003c/p\u003e\n\u003cp\u003ePost-intervention comparisons between groups revealed significantly higher scores in several specific comfort subdomains for the Quran recitation group. Sociocultural comfort was higher in the intervention group (22.00 ± 2.21) compared to the control group (19.83 ± 2.37), with a \u003cem\u003ep\u003c/em\u003e-value of 0.002. Similarly, the relief subdomain showed a significant difference, with mean scores of 22.60 ± 2.21 for the intervention group and 18.93 ± 2.37 for the control group (\u003cem\u003ep\u003c/em\u003e = 0.002). Transcendence scores were also significantly higher in the Quran group (12.03 ± 1.67) than in the control group (11.23 ± 1.43), (\u003cem\u003ep\u003c/em\u003e = 0.025). No statistically significant differences were found between the groups in the physical, psychospiritual, or environmental comfort subdomains (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eThese results indicate that Quran recitation was more effective than back massage in improving overall childbirth comfort, particularly in dimensions related to sociocultural support, perceived relief, and spiritual transcendence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBlood pressure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood pressure was assessed at two stages of cervical dilation (4–6 cm and 7–9 cm) before and after the intervention. In the Quran recitation group, both systolic and diastolic pressures decreased significantly following the intervention. At 4–6 cm dilation, systolic pressure declined from 115.4 ± 11.7 mmHg to 100.8 ± 8.99 mmHg, and diastolic pressure decreased from 88.31 ± 6.45 mmHg to 77.92 ± 9.83 mmHg (p \u0026lt; 0.001 for both). At 7–9 cm dilation, systolic pressure dropped from 135.75 ± 8.51 mmHg to 127.69 ± 7.63 mmHg, and diastolic pressure from 90.00 ± 4.73 mmHg to 80.66 ± 6.76 mmHg (p \u0026lt; 0.001). These findings are visualized in \u003cstrong\u003eFigure 1\u003c/strong\u003e, which illustrates the significant hemodynamic stabilizing effect of Quran recitation during active labor.\u003c/p\u003e\n\u003cp\u003eMultivariate linear regression analyses were conducted to assess the effect of the intervention while adjusting for gestational age, time of admission, and prior Quran exposure. After controlling for these covariates:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eQuran recitation remained a significant predictor of lower post-intervention pain intensity (β = –0.61, p \u0026lt; 0.001).\u003c/li\u003e\n \u003cli\u003eIt was also significantly associated with higher total childbirth comfort scores (β = 0.48, p = 0.003), particularly in the sociocultural and relief subdomains.\u003c/li\u003e\n \u003cli\u003eSystolic and diastolic blood pressure reductions remained significant (β = –0.53 and –0.49, respectively; both p \u0026lt; 0.001).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eGestational age was not independently associated with pain or comfort outcomes (p \u0026gt; 0.05), though it showed a mild association with systolic blood pressure (p = 0.048). These results confirm that the observed benefits of Quran recitation were not confounded by gestational age or other covariates. \u003cstrong\u003e(Table-5)\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to compare the effects of Quran listening and back massage on labor pain, pain behaviors, childbirth comfort, and blood pressure among parturient women. The findings revealed that listening to the Quran was significantly more effective than back massage in reducing pain intensity, enhancing pain-coping behaviors, increasing childbirth comfort, and stabilizing maternal blood pressure during labor.\u003c/p\u003e \u003cp\u003eThe baseline sociodemographic and obstetric characteristics of the two groups were largely comparable, with the exception of gestational age, which differed significantly (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.028); more women in the control group delivered between 38\u0026ndash;40 weeks. This variation may influence labor experiences such as pain perception or progression and should be acknowledged as a potential confounding factor. Nevertheless, the similarity across most baseline variables supports the internal validity of the study, strengthening the attribution of post-intervention differences to the effects of the interventions.\u003c/p\u003e \u003cp\u003eThe consistently significant improvements observed in the Quran recitation group across multiple independent domains\u0026mdash;including pain intensity, behavioral responses, comfort levels, and physiological parameters\u0026mdash;further reinforce the robustness of the findings. Particularly, large effect sizes in pain reduction (Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.0), blood pressure regulation (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.00\u0026ndash;1.42), and comfort subdomains such as relief (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.59) suggest that the intervention\u0026rsquo;s effectiveness is unlikely to be solely explained by differences in gestational age. Future studies should consider adjusting for gestational age using stratified analysis or multivariate modeling to further isolate the effect of the intervention.\u003c/p\u003e \u003cp\u003eThe significant reduction in VAS scores among mothers who listened to the Quran indicates that Quran recitation is an effective non-pharmacological method for alleviating labor pain. This is consistent with previous research suggesting that exposure to Quranic recitation promotes relaxation, reduces anxiety, and modulates pain perception through both auditory and spiritual pathways (e.g., activation of the parasympathetic nervous system and reduction in cortisol levels). In contrast, the control group receiving back massage exhibited minimal, non-significant pain reduction, indicating that while physical touch may offer some relief, it is less effective than spiritually oriented auditory stimulation in altering pain perception. These findings align with earlier studies showing that listening to spiritual or religious recitations enhances endorphin release and reduces pain perception during labor. \u003csup\u003e\u003cb\u003e23\u0026ndash;25\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Quran listening group also demonstrated significant improvements across all five domains of pain-related behaviors\u0026mdash;vocalization, body movement, breathing control, facial expression, and communication\u0026mdash;indicating better coping and self-regulation during labor. This suggests that the intervention may foster psychological relaxation and strengthen spiritual resilience, enabling mothers to endure contractions with improved breathing patterns, emotional control, and verbal communication. By comparison, the control group showed improvements only in body movement and communication, reflecting the limited impact of massage on deeper cognitive and emotional coping mechanisms. These observations are consistent with prior studies indicating that religious interventions enhance emotional regulation and coping during childbirth, resulting in more positive labor experiences \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn terms of childbirth comfort, Quran listening significantly improved total comfort scores and specific subdomains, including sociocultural comfort, relief, and transcendence. This suggests that the intervention not only reduced physical pain but also enhanced emotional, spiritual, and social well-being. Listening to the Quran likely evoked a sense of divine presence and reassurance, helping mothers feel spiritually connected, emotionally supported, and psychologically safe. In contrast, back massage, while offering some physical relief, did not significantly affect overall comfort\u0026mdash;particularly in the spiritual or transcendent domains. These findings are supported by studies emphasizing the spiritual dimension of maternal comfort, in which faith-based auditory interventions foster trust, relaxation, and a sense of optimism during labor. \u003csup\u003e\u003cb\u003e28\u0026ndash;29\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSignificant reductions in both systolic and diastolic blood pressure were observed in the Quran listening group, indicating a strong hemodynamic stabilizing effect. This physiological response is characteristic of a relaxation state, likely mediated by reduced sympathetic arousal and enhanced parasympathetic activity. In contrast, the control group experienced no significant changes in blood pressure, further highlighting the superior physiological impact of Quran recitation. Similar effects have been documented in previous studies, where listening to Quranic verses reduced blood pressure, heart rate, and stress hormone levels in pregnant women and during various medical procedures\u003csup\u003e\u003cb\u003e\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCollectively, these findings suggest that Quran listening is a powerful, non-invasive, and culturally appropriate intervention that addresses the physical, psychological, and spiritual dimensions of maternal well-being during labor. It effectively reduces pain, enhances coping behaviors, promotes comfort, and stabilizes physiological parameters\u0026mdash;without adverse effects making it a promising adjunct to maternity care, particularly in culturally aligned settings.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Recommendations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. The quasi-experimental, non-randomized design with convenience sampling may have introduced selection bias and limits generalizability. Sequential recruitment over different months may have caused time-related confounding, despite consistent care protocols. The lack of blinding and use of observer-rated behavioral tools could also introduce bias. Future studies should use randomized controlled trials with parallel groups, blinded assessors, and broader sampling to improve validity. A significant difference in gestational age was found between groups (p\u0026thinsp;=\u0026thinsp;0.028), with more control participants delivering at 38\u0026ndash;40 weeks. Although regression analysis adjusted for this variable, future research should use subgroup analyses by gestational age to ensure the effects are independent of maturity at delivery.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that listening to Quran recitation is significantly more effective than back massage in reducing labor pain, enhancing pain-coping behaviors, improving maternal comfort, and stabilizing blood pressure among nulliparous women. As a non-pharmacological, culturally appropriate, and spiritually meaningful intervention, Quran recitation offers a holistic approach to labor support that addresses both physical and emotional dimensions of childbirth. Its ease of implementation, safety profile, and cultural acceptability make it a valuable adjunct to routine obstetric care, particularly in Islamic settings.\u003c/p\u003e \u003cp\u003eGiven the limitations of this quasi-experimental design, future research should utilize randomized controlled trials to confirm these findings and explore underlying neurophysiological mechanisms. Additional comparisons with other auditory and relaxation-based interventions could further delineate the unique contributions of spiritual content to maternal outcomes. Integration of Quran recitation into maternity care protocols has the potential to enhance childbirth experiences, promote maternal well-being, and support personalized, respectful labor care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to thank the staff of Khoula Hospital, Oman, and the Ministry of Health for their support and cooperation. Special thanks are extended to the participating mothers and the midwifery team for their valuable contributions to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This study was reviewed and approved by the Research and Ethics Committee of Khoula Hospital, Oman, and the Research and Ethical Review and Approval Committee (RERAC) of the Ministry of Health, Oman (Approval Code: PRO 0092019043B). Informed written consent was obtained from all participants prior to inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMcKelvin G, Thomson G, Downe S. The childbirth experience: A systematic review of predictors and outcomes. Women and Birth. 2021 Sep 1;34(5):407-16.\u003c/li\u003e\n \u003cli\u003eOlza I, Uvnas-Moberg K, Ekstr\u0026ouml;m-Bergstr\u0026ouml;m A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, Villarmea S, Hadjigeorgiou E, Kazmierczak M, Spyridou A, Buckley S. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. Plos one. 2020 Jul 28;15(7):e0230992.\u003c/li\u003e\n \u003cli\u003eLauth C, Huet J, Dolley P, Thibon P, Dreyfus M. 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The Influence of Caesarean Section Education Program and Quranic Recitation Therapy on Anxiety Levels in Preoperative Patients at RA Kartini Hospital, Jepara Regency. Journal of Health Education. 2023 Apr 30;8(1):31-40.\u003c/li\u003e\n \u003cli\u003eSAFARZADEH A, Khodakarami N, Fathizadeh N, SAFDARI DF. The effect of massage therapy on the severity of labor in primiparous women.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGallo RB, Santana LS, Ferreira CH, Marcolin AC, PoliNeto OB, Duarte G, Quintana SM.Massage \u0026nbsp;reduced severity of pain during labour: a randomized trial. Journal of physiotherapy. 2013 Jun 1;59(2):109-16.\u003c/li\u003e\n \u003cli\u003eJensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986 Oct 1;27(1):117-26.\u003c/li\u003e\n \u003cli\u003eMyles PS, Urquhart N. The linearity of the visual analogue scale in patients with severe acute pain. Anaesthesia and intensive care. 2005 Feb;33(1):54-8.\u003c/li\u003e\n \u003cli\u003eFrasca M, Burucoa B, Domecq S, Robinson N, Dousset V, Cadenne M, Sztark F, Floccia M. Validation of the Behavioural Observation Scale 3 for the evaluation of pain in adults. European Journal of Pain. 2017 Oct;21(9):1475-84.\u003c/li\u003e\n \u003cli\u003eSchuiling KD. Exploring the presence of comfort within the context of childbirth. University of Michigan; 2003.\u003c/li\u003e\n \u003cli\u003ePotur DC, Merih YD, K\u0026uuml;lek H, G\u0026uuml;rkan \u0026Ouml;C. The validity and reliability of the Turkish version of the childbirth comfort questionnaire. Journal of Anatolia Nursing and Health Sciences. 2015;18(4):252-8.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eHow Surah Maryam guided me during my pregnancy\u003c/em\u003e [Internet]. 2020 Dec 22 [cited 2026 Jan 19]. Available from: https://muslimahinspiration.com/2020/12/22/article-how-surah-maryam-guided-me-during-my-pregnancy/\u003c/li\u003e\n \u003cli\u003eKimber L, McNabb M, Mc Court C, Haines A, Brocklehurst P. Massage or music for pain relief in labour: a pilot randomised placebo controlled trial. European Journal of pain. 2008 Nov 1;12(8):961-9.\u003c/li\u003e\n \u003cli\u003eGouda Nasr ES, M Omar A, Mohamed Hegazy S. Effect of Listening to Holy Qur\u0026apos;an during labor on its Progress, Maternal and Neonatal outcome. Egyptian Journal of Health Care. 2021 Mar 1;12(1):1-5.\u003c/li\u003e\n \u003cli\u003eEl-Sayed HE, Saadoon OH, Saadoon MM. Effect of listening to holy Quran on maternal and neonatal outcomes among Muslim Primiparous during the active phase of labor. International Journal of Novel Research in Healthcare and Nursing. 2020;7(2):115-26.\u003c/li\u003e\n \u003cli\u003eRababa M, Al-Sabbah S, Hayajneh A. The Impact of Listening to Quran Recitation during Pain-Inducing Procedure among Patients Receiving Mechanical Ventilation Support: An Interventional Study. Iranian Journal of Nursing and Midwifery Research. 2025 Jan 1;30(1): 34-40.\u003c/li\u003e\n \u003cli\u003eKongsuwan W, Chatchawet W. Effect of nursing intervention integrating an Islamic praying program on labor pain and pain behaviors in primiparous Muslim women. Iranian journal of nursing and midwifery research. 2019 May 1;24(3):220-6.\u003c/li\u003e\n \u003cli\u003eMenza R, Bongiovanni T, Leutwyler H, Tang J, Johnson JK, Howie-Esquivel J. Music-based interventions for symptom management in critically ill, mechanically ventilated adults: A scoping review of the literature. Journal of integrative and complementary medicine. 2024 Nov 1;30(11):1047-71.\u003c/li\u003e\n \u003cli\u003eAbdollahpour S, Khosravi A. Relationship between spiritual intelligence with happiness and fear of childbirth in Iranian pregnant women. Iranian journal of nursing and midwifery research. 2018 Jan 1;23(1):45-50.\u003c/li\u003e\n \u003cli\u003eSimonovich SD, Quad N, Kanji Z, Tabb KM. Faith practices reduce perinatal anxiety and depression in Muslim women: a mixed-methods scoping review. Frontiers in psychiatry. 2022 May 24; 13:826769.\u003c/li\u003e\n \u003cli\u003eMansouri A, Vahed AS, Sabouri AR, Lakzaei H, Arbabisarjou A. Investigating Aid Effect of Holy Quran Sound on Blood Pressure, Pulse, Respiration and O. Int J Sci Study. 2017;5(7).\u003c/li\u003e\n \u003cli\u003eNingsih E, Islamiyati I, Riyanto R, Gumelar R. The Impact of the Combination Therapy of Listening to the Holy Quran and Progressive Muscle Relaxation on Blood Pressure Reduction in Women of Reproductive Age with Hypertension: A Randomized Controlled Trial Study. Jurnal Kesehatan Metro Sai Wawai. 2024 Jun 28;17(1):28-36.\u003c/li\u003e\n \u003cli\u003eMeiranny A, Rahmawati A, Arisanti AZ. Is Prenatal Exercise with Prayer Movement Affecting Anxiety Level and Blood Pressure in Third Trimester?. Jurnal Kesehatan Masyarakat. 2022 Mar 17;17(3):329-41.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable-1 Sociodemographic and Obstetric Characteristics of Participants\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"780\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 25.0315%;\"\u003e\n \u003cp\u003eIntervention group (n=60 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 24.0332%;\"\u003e\n \u003cp\u003eControl group (n= 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026chi;\u0026sup2; \u0026nbsp;test\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-\u0026nbsp;value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;4.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp; 0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; 20\u0026ndash;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; 25\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e26\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e43.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; 30\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026ge;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eMother\u0026rsquo;s education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eUp to 12\u003csup\u003eth\u003c/sup\u003e grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e40.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Graduate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e41.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e63.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Postgraduate and \u0026nbsp;above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e25.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eMother\u0026rsquo;s employment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e56.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Not employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e43.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e53.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eGestational age (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.028*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; 36-37 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e46.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; 38-40weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e53.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026gt;40 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eTime of admission to delivery room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Latent phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e81.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e85.0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Active phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e18.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e15.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eType of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Vaginal birth without episiotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e63.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e58.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Vaginal birth with episiotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e36.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e41.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eFamily structure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Nuclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e86.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp; Extended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6646%;\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0764%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Values are expressed as frequencies and percentages. \u0026chi;\u0026sup2; test was applied to compare groups. *p* \u0026lt; 0.05 was considered statistically significant. *Statistically significant difference at *p* \u0026lt; 0.05.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison of Visual Analogue Scale (VAS) scores for labor pain before and after the intervention (N = 120)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"768\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBefore Intervention \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAfter Intervention (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eQuran Recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.45 \u0026plusmn; 8.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.32 \u0026plusmn; 7.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBack Massage (Control)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62.88 \u0026plusmn; 8.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.10 \u0026plusmn; 7.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Data are expressed as mean \u0026plusmn; standard deviation. VAS = Visual Analogue Scale (0 = no pain, 100 = worst imaginable pain). Paired t-test was applied to compare pre- and post-intervention scores. *Statistically significant at p \u0026lt; 0.05.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable- 3. Pain\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Behavioral Observation Scale (PBOS-3) Scores Before and After the Intervention (with CI and Effect Size)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"774\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eDomain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003ePre (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003ePost (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003et (df)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eVocalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eQuran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e26.83 \u0026plusmn; 3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e28.31 \u0026plusmn; 3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e2.08 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e[0.50, 2.46]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e27.89 \u0026plusmn; 3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e28.40 \u0026plusmn; 3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e1.25 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eBody Movement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eQuran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e32.31 \u0026plusmn; 3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e33.60 \u0026plusmn; 3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e2.19 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.045*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e[0.03, 2.57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e32.88 \u0026plusmn; 3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e30.61 \u0026plusmn; 3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e5.86 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eBreathing Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eQuran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e27.66 \u0026plusmn; 3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e31.70 \u0026plusmn; 3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e4.04 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e[2.09, 5.82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e34.45 \u0026plusmn; 1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e35.45 \u0026plusmn; 4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e1.56 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eFacial Expression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eQuran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e26.95 \u0026plusmn; 3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e29.60 \u0026plusmn; 3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e2.45 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e[0.83, 4.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e26.86 \u0026plusmn; 3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e25.89 \u0026plusmn; 3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e1.30 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eCommunication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eQuran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e27.77 \u0026plusmn; 3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e31.60 \u0026plusmn; 3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e4.02 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 94px;\"\u003e\n \u003cp\u003e[2.01, 5.38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e27.73 \u0026plusmn; 3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e31.70 \u0026plusmn; 3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e4.06 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote- PBOS-3 scores range from 5 to 15 per domain. Each domain is rated on a 3-point scale \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(1 =severe pain,3 =minimal pain). Higher scores indicate improved behavioral coping and reduced pain expression. A decrease in score reflects worsening pain behavior. Statistical significance is based on paired t-tests within each group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable-4 Comparison of Childbirth Comfort Questionnaire (CCQ) Scores After Intervention Between Groups (with CI and Effect Size)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"774\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eComfort Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQuran Group(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eControl Group(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI (Between-group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Comfort Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.13 \u0026plusmn; 3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.05 \u0026plusmn; 3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[1.47, 6.74]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePhysical Comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.01 \u0026plusmn; 1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.20 \u0026plusmn; 2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[\u0026ndash;0.06, 1.65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePsychospiritual Comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.46 \u0026plusmn; 1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00 \u0026plusmn; 2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[\u0026ndash;0.74, 1.65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEnvironmental Comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.43 \u0026plusmn; 1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.63 \u0026plusmn; 1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[\u0026ndash;0.12, 1.68]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSociocultural Comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.00 \u0026plusmn; 2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.83 \u0026plusmn; 2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.80, 3.55]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRelief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.60 \u0026plusmn; 2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.93 \u0026plusmn; 2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[1.55, 5.04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTranscendence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.03 \u0026plusmn; 1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.23 \u0026plusmn; 1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.025*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e[0.10, 1.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003eTable-5. Multivariate Linear Regression Analyses Adjusting for Gestational Age, Time of Admission, and Prior Quran Exposure\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"738\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictor (Quran Recitation vs. Back Massage)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized \u0026beta; Coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003ePost-intervention pain intensity (VAS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026ndash;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eChildbirth comfort (total CCQ score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCCQ Subdomains\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u0026ndash; Physical comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u0026ndash; Psychospiritual comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u0026ndash; Environmental comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u0026ndash; Sociocultural comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u0026ndash; Relief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u0026ndash; Transcendence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eSystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026ndash;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eDiastolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003eQuran recitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026ndash;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-the-egyptian-public-health-association","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jepa","sideBox":"Learn more about [Journal of the Egyptian Public Health Association](http://jepha.springeropen.com)","snPcode":"42506","submissionUrl":"https://submission.nature.com/new-submission/42506/3","title":"Journal of the Egyptian Public Health Association","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Quran recitation, labor pain, childbirth comfort, blood pressure, non-pharmacological interventions, spiritual care, nulliparous women, Oman","lastPublishedDoi":"10.21203/rs.3.rs-8666369/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8666369/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Labor pain and childbirth comfort significantly affect maternal satisfaction, labor progression, and psychological well-being. Non-pharmacological methods are increasingly explored to manage labor pain safely and holistically. Quran recitation, a culturally and spiritually rooted auditory intervention, may offer psychological and physiological benefits during childbirth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To evaluate the effectiveness of Quran recitation in reducing labor pain intensity, comfort \u0026nbsp;during childbirth, and blood pressure among nulliparous women in Oman.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A quasi-experimental study was conducted at Khoula Hospital, Oman, involving 120 nulliparous women with singleton term pregnancies. Participants were assigned to either the Quran recitation group (n = 60) or the back massage group (n = 60). Data were collected using the Visual Analogue Scale (VAS), Pain Behavioral Observation Scale (PBOS-3), Childbirth Comfort Questionnaire (CCQ), and physiological measures of blood pressure. Pre- and post-intervention comparisons were performed using paired t-tests and ANOVA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Quran recitation significantly reduced mean VAS pain scores (76.45 ± 8.20 to 58.32 ± 7.16, \u003cem\u003ep\u003c/em\u003e = 0.001) compared to back massage, which showed a non-significant change (62.88 ± 8.44 to 61.10 ± 7.98, \u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05). The intervention group also demonstrated significant improvements in pain behaviors, comfort levels (total CCQ score \u003cem\u003ep\u003c/em\u003e = 0.002), and reductions in systolic and diastolic blood pressure (\u003cem\u003ep\u003c/em\u003e = 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Quran recitation is a safe, culturally congruent, and effective non-pharmacological intervention for reducing labor pain and enhancing maternal comfort. It has physiological calming effects and can be considered as a complementary strategy in obstetric care for Muslim women.\u003c/p\u003e","manuscriptTitle":"Impact of Quran Recitation on Labor Pain, Maternal Comfort, and Blood Pressure: A Quasi-Experimental Study in Nulliparous Women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 12:23:07","doi":"10.21203/rs.3.rs-8666369/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-09T08:23:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T13:12:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T01:35:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16047333649327358408434493476896317957","date":"2026-02-25T04:10:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110705444205821533433063191021693482606","date":"2026-02-23T23:14:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T09:24:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266657267325458262308380510543672718838","date":"2026-02-10T05:32:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-09T19:29:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T06:01:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-30T05:59:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of the Egyptian Public Health Association","date":"2026-01-22T06:47:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-the-egyptian-public-health-association","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jepa","sideBox":"Learn more about [Journal of the Egyptian Public Health Association](http://jepha.springeropen.com)","snPcode":"42506","submissionUrl":"https://submission.nature.com/new-submission/42506/3","title":"Journal of the Egyptian Public Health Association","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fc84619-e751-4be7-8832-c4753241a670","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T08:41:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 12:23:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8666369","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8666369","identity":"rs-8666369","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}