The Effects Of Mother-Friendly Practices On Maternal And Fetal Outcomes: A Multicenter Study

The Effects Of Mother-Friendly Practices On Maternal And Fetal Outcomes: A Multicenter Study | 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 The Effects Of Mother-Friendly Practices On Maternal And Fetal Outcomes: A Multicenter Study Merve Keskin Paker, Ayşe Beyaz, Gülsün Ucar, Merve Kaplan Kaya, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7810597/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Apr, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction and Objective: From early pregnancy to postpartum discharge, avoiding unnecessary non-evidence-based interventions and supporting natural physiological processes form the basis of the “mother-friendly hospital” model, a new program designed to enhance care quality. This study evaluated the impact of implementing mother-friendly hospital criteria on pain during labor, maternal satisfaction, and maternal and fetal outcomes. Materials and Methods: This prospective study included women with term pregnancies who delivered between February and June 2025 at Sakarya Research and Training Hospital (Group 1, with mother-friendly practices) and Ümraniye Research and Training Hospital (Group 2, without such practices). Exclusion criteria were maternal age > 45 years, chronic systemic disease (e.g., diabetes, hypertension, renal or hepatic disease), preeclampsia or gestational diabetes, premature rupture of membranes > 12 hours with chorioamnionitis findings, preterm birth (< 37 weeks), and small-for-gestational-age infants (< 2 SD). Maternal characteristics (age, education, cervical dilation, gestational week, childbirth education, delivery interventions, postpartum hemorrhage, non-pharmacological methods, duration of labor), pain levels using the Visual Analog Scale (VAS), and fetal outcomes (birth weight, Apgar scores, neonatal intensive care unit [NICU] admission) were recorded. Maternal satisfaction was assessed in the first postpartum hour using the Birth Satisfaction Scale. Results: A total of 281 women were enrolled (Group 1: 136, Group 2: 145). No significant differences were found between groups regarding age, body mass index, education, employment status, gestational week, labor duration, or postpartum hemorrhage (p > 0.05). Latent phase, active phase, and postpartum VAS scores were significantly lower in Group 1 compared with Group 2 (p < 0.001). Maternal satisfaction scores were significantly higher in Group 1 (p < 0.001). NICU admission was significantly less frequent in Group 1 (2.9% vs. 9.7%, p = 0.022). First- and fifth-minute Apgar scores were also higher in Group 1 newborns (p < 0.001 for both). Conclusion: Mother-friendly hospital practices, emphasizing minimal intervention and physiologic support, significantly reduce pain during labor, increase maternal satisfaction, and improve neonatal outcomes. Ensuring safe, high-quality, and mother-centered maternity care is a fundamental right for all women and can be achieved through implementation of mother-friendly approaches. Mother-friendly Maternal satisfaction Maternal outcomes Fetal outcomes INTRODUCTION Childbirth has been perceived differently across many cultures throughout history, and various care and monitoring practices have been implemented. In recent years, the shift of childbirth from a physiological process to a more medically intervened domain has significantly affected women’s childbirth experiences. This shift may jeopardize the rights of women to make decisions regarding childbirth and their opportunity to experience this process naturally ( 1 ). Today, the main goal in obstetric practice is to ensure that labor occurs under appropriate conditions with minimal intervention and in a normal manner ( 1 ). It has begun to be accepted that from the beginning of pregnancy until postpartum discharge, non-evidence-based medical interventions should be avoided, necessary interventions should be applied only when required, and the process should progress in its natural physiology ( 2 ). Supportive care and professional support during labor assist the woman’s sense of control and her efforts to cope with labor pain. Supportive care includes practices such as providing physical and emotional support and delivering information. Previous studies have shown that supportive care during labor positively affects maternal and infant outcomes and reduces interventions during labor. Therefore, patient satisfaction related to childbirth is considered an indicator of the quality of obstetric care ( 3 ). To increase satisfaction levels related to childbirth, it is recommended that mothers be supported physically and psychologically by midwives during labor. Additionally, respecting privacy, early skin-to-skin contact, and the presence of a companion who makes the mother feel comfortable are necessary for a pleasant and comfortable childbirth experience ( 4 ). In recent years, the relationship between poor quality of care and negative maternal outcomes has been emphasized globally. The World Health Organization (WHO) has published a guide and various recommendations to address labor management in response to the needs of countries. With this guide published by WHO in 2018, respectful maternity care, which forms the basis of labor management, aims to increase childbirth satisfaction and fundamentally protect maternal and newborn health. The importance of providing respectful and supportive care to women during labor is emphasized ( 1 ). Receiving safe and high-quality pregnancy monitoring and childbirth services is the right of all expectant mothers. The strategy developed by the International Federation of Gynecology and Obstetrics (FIGO) and WHO in response to these issues includes the “Mother- and Baby-Friendly Birthing Facilities Initiative” ( 5 ). In this context, the concept of the “mother-friendly hospital” is a program that will improve and further the quality of services provided for pregnancy and childbirth. In Türkiye, the foundations of the “mother-friendly hospital” approach were first laid by the Turkish Ministry of Health in 2011, and the “mother-friendly hospital program” was published. The aim of the program is to increase the quality and quantity of maternal health services and ensure that expectant mothers have access to safe and high-quality obstetric services. In the mother-, baby-, and family-friendly model, the establishment of single-person “Birthing Units” based on privacy is essential. The goal is to encourage vaginal birth and reduce intervention rates. With a suitable companion, participants should feel comfortable, as if in a home environment, and be provided with freedom of movement ( 15 ). Today, the number of Mother-Friendly Hospitals across Türkiye has reached 183. The Obstetrics Clinics of Sakarya Research and Training Hospital received the title of Mother-Friendly Hospital on 4 October 2023. In this study, it was aimed to evaluate the effects of mother-friendly hospital criteria on pain scores during labor, maternal satisfaction, and maternal and fetal outcomes between two institutions, one where mother-friendly criteria were implemented and one where they were not. MATERIAL AND METHOD Ethical Procedure This study was planned as a prospective case-control study. All participants were informed about the content of the study, and consent forms were obtained. The study protocol was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Sakarya University Clinical Research Ethics Committee (Project ID: E-43012747-050.04-438233-43). Population: The Obstetrics Clinics of Sakarya Research and Training Hospital, where the study was conducted, received the title of Mother-Friendly Hospital on 4 October 2023. According to this program, physical conditions were improved, and the operations of the delivery team were standardized. As a result, patients experience a childbirth process in single-person rooms, accompanied by a companion, and supported by midwives with minimal intervention. Since the Obstetrics and Gynecology Clinics of Ümraniye Research and Training Hospital have not yet received the title of Mother-Friendly Hospital, standard care and monitoring services are provided in their delivery rooms. Between February 2025 and June 2025, a total of 281 women who gave birth at term were included in the study. Women over the age of 45, those with multiple pregnancies, maternal type 1 and type 2 diabetes mellitus or gestational diabetes, chronic hypertension, preeclampsia, connective tissue disease, chronic kidney and liver disease, and hematological diseases were not included in the study. Pregnancies with preterm birth (gestational age < 37 weeks), small-for-gestational age infants (birth weight < 2 SD), neonatal asphyxia (Apgar score < 7 at the first and fifth minutes), malformations, chromosomal diseases, and congenital infections were excluded from the study. Age, education level, gestational week at admission to the delivery room, cervical dilation, childbirth education status, interventions during labor (enema, episiotomy, vacuum, forceps), and non-pharmacological methods applied were recorded. Pain scores during labor were measured using the Visual Analog Scale (VAS), and mode of delivery, postpartum hemorrhage (PPH) status, and duration of stay in the delivery room were recorded. For fetal outcomes, fetal weight at birth, Apgar scores, and neonatal intensive care unit requirements were recorded. The Scale for Measuring Maternal Satisfaction in Birth was completed by the participants in the first postpartum hour ( 6 ). Visual Analog Scale (VAS): VAS is used to assess the intensity of pain. An eleven-point scale was used during the assessment, where “0” represented “no pain”, and “10” represented “the most severe pain imaginable.” VAS is evaluated on a 100 mm horizontal line. Participants are told that the left end of the scale means “no pain” and that the right end means “the most severe pain imaginable.” It allows pain measurement based on the participant’s own statement, categorized from no pain to severe pain at specific intervals. Pain scores during the latent and active phases of labor and at different postpartum times were recorded. Based on the amount of cervical dilation, the latent phase was defined as 0–6 cm, and the active phase was defined as 6–10 cm. Scale for Measuring Maternal Satisfaction in Birth: The scale consists of 43 items and 10 dimensions. The dimensions of the scale are Perception of the Healthcare Team, Nursing Care During Labor, Comforting, Participation in Decisions and Information, Meeting the Baby, Postpartum Care, Hospital Room, Hospital Facilities, Respect for Privacy, and Meeting Expectations. The Cronbach’s alpha internal consistency coefficient of the scale was found to be 0.91. The scale can be completed by mothers themselves. Items are scored on a five-point Likert-type scale according to the respondent’s degree of agreement (1-Strongly disagree, 2-Partially agree, 3-Neutral, 4-Agree, and 5-Strongly agree). Thirteen items (7, 8, 9, 10, 19, 20, 21, 22, 35, 36, 38, 41, and 42) are scored in reverse. To calculate scale scores, the items that are scored in reverse are first converted. In reversing item scores, the response options “1-Strongly disagree, 2-Partially agree, 3-Neutral, 4-Agree, and 5-Strongly agree” become “5-Strongly disagree, 4-Partially agree, 3-Neutral, 2-Agree, and 1-Strongly agree.” After reversing the scores of these items, the sum of the scores of all items in the scale gives the “total scale score.” The sum of the items forming each dimension can be used as the “total dimension score.” The total raw score ranges from 43 to 215. Higher total scale scores indicate higher levels of satisfaction of mothers with the care received during vaginal birth in the hospital. The cut-off score calculated for the Scale for Measuring Maternal Satisfaction in Birth was determined as 150.5 (≥ 150.5 indicates high satisfaction levels, < 150.5 indicates low satisfaction levels) ( 6 ). Statistical analysis The analyses were conducted using the SPSS (Statistical Package for the Social Sciences; SPSS Inc., Chicago, IL) version 22 software package. Descriptive data are presented as n and % for the categorical variables and as mean ± standard deviation (X ± SD) for the continuous variables. Pearson’s chi-squared tests were applied for the comparisons of the categorical variables between groups. The normality of the distribution of the continuous variables was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparisons of two groups, and the Kruskal-Wallis test was used for comparisons of more than two groups. The relationships between variables were evaluated using Spearman’s correlation analysis. A statistical significance level of p < 0.05 was accepted in all analyses. RESULTS A total of 281 participants who gave birth at term in the delivery rooms of Sakarya Research and Training Hospital (Group 1, n = 136), where mother-friendly approaches were implemented, and Ümraniye Research and Training Hospital (Group 2, n = 145), where mother-friendly approaches were not implemented, were included in the study. No statistically significant differences were found between Group 1 and Group 2 in terms of age, body mass index (BMI), education level, employment status, gestational week, duration of stay in the delivery room, and postpartum hemorrhage (PPH) rates (p > 0.05). The initial cervical examinations performed at admission for the participants in Group 1 revealed significantly higher cervical dilation values than those in Group 2 (p < 0.001). The rate of receiving childbirth-related education before delivery among the participants in Group 1 (31.6%) was significantly lower than the rate in Group 2 (53.1%) (p < 0.001) (Table 1 ). Table 1 Demographic characteristics of the participants Group 1 Group 2 p * X ± SD X ± SD Age 25.40 ± 4.15 26.15 ± 3.66 0.063 Height 161.84 ± 5.86 161.54 ± 5.61 0.600 Weight 76.82 ± 13.26 78.05 ± 14.45 0.461 BMI 29.34 ± 4.84 29.87 ± 5.23 0.391 Gestational week 39.23 ± 1.22 39.10 ± 1.56 0.790 Cervical dilation at admission (cm) 3.68 ± 2.15 2.61 ± 2.18 < 0.001 n % n % p ** Education level High school or below 100 73.5 105 72.4 0.833 University or above 36 26.5 40 27.6 Employment status Working 31 22.8 36 24.8 0.689 Not working 105 77.2 109 75.2 Reads sources about childbirth Yes 54 39.7 56 38.6 0.852 No 82 60.3 89 61.4 Received education about childbirth before giving birth Yes 43 31.6 77 53.1 < 0.001 No 93 68.4 68 46.9 Postpartum hemorrhage Yes 11 8.1 7 4.8 0.265 No 125 91.9 138 95.2 BMI: Body Mass Index , * Mann-Whitney U test, ** Chi-squared test. The rate of neonatal intensive care unit admissions among the participants in Group 1 (2.9%) was significantly lower than that of those in Group 2 (9.7%) (p = 0.022). The Apgar scores at the 1st minute (p < 0.001) and 5th minute (p < 0.001) for the newborns of the participants in Group 1 were significantly higher than those in Group 2 (Table 2 ). It was shown that mother-friendly approaches and minimal intervention during pregnancy and childbirth directly and positively affected fetal outcomes. Table 2 Fetal outcomes in the groups Group 1 Group 2 p * n % n % NICU admission Yes 4 2.9 14 9.7 0.022 No 132 97.1 131 90.3 X ± SD X ± SD p ** Weight of baby 3280.00 ± 373.11 3224.52 ± 455.97 0.459 1st min. Apgar 8.61 ± 1.65 8.04 ± .82 < 0.001 5th min. Apgar 9.55 ± 1.86 9.22 ± 1.08 < 0.001 NICU: Neonatal Intensive Care Unit , * Chi-squared test, ** Mann-Whitney U test. Among the participants in Group 1, the rupture of the membranes occurred at home in 30.9%, spontaneously in 41.2%, and via amniotomy in 27.9%, whereas in Group 2, ruptures occurred at home in 33.1%, spontaneously in 24.1%, and via amniotomy in 42.8%. A statistically significant difference was observed between the groups (p = 0.005) (Table 3 ). The rate of labor induction among the participants in Group 1 (49.3%) was significantly lower than that of those in Group 2 (71%) (p < 0.001). The rate of enema application among the participants in Group 1 (0.7%) was significantly lower than the rate in Group 2 (5.5%) (p = 0.037) (Table 3 ). The rate of perineal tear occurrence among the participants in Group 1 (24.6%) was significantly lower than the rate in Group 2 (39.4%) (p = 0.009). The rate of Kristeller maneuver application among the participants in Group 1 (13.3%) was significantly lower than the rate in Group 2 (30.4%) (p = 0.001) (Table 3 ). Among the participants in Group 1, 8.1% breastfed immediately, 42.6% breastfed within half an hour, 44.9% breastfed within one hour, 2.9% breastfed within two hours, and 1.5% did not breastfeed. In Group 2, 4.8% breastfed immediately, 35.9% breastfed within half an hour, 34.5% breastfed within one hour, 17.9% breastfed within two hours, and 6.9% did not breastfeed. A statistically significant difference was observed between the groups (p < 0.001) (Table 3 ). Table 3 Interventions applied in the groups Group 1 Group 2 p * n % n % Membrane rupture Home 42 30.9 48 33.1 0.005 Spontaneous 56 41.2 35 24.1 Amniotomy 38 27.9 62 42.8 Labor induction Yes 67 49.3 103 71.0 < 0.001 No 69 50.7 42 29.0 Enema Yes 1 .7 8 5.5 0.037 No 135 99.3 137 94.5 Perineal tear Yes 33 24.6 56 39.4 0.009 No 101 75.4 86 60.6 Kristeller maneuver Yes 18 13.3 42 30.4 0.001 No 117 86.7 96 69.6 Breastfeeding time Immediate 11 8.1 7 4.8 < 0.001 Within ½ h 58 42.6 52 35.9 Within 1 h 61 44.9 50 34.5 Within 2 h 4 2.9 26 17.9 No feeding 2 1.5 10 6.9 Pain alleviation methods Yes 100 73.5 44 30.6 < 0.001 No 36 26.5 100 69.4 X ± SD X ± SD p ** Duration of stay in delivery room 764.85 ± 540.18 886.51 ± 865.22 0.989 * Chi-squared test, ** Mann-Whitney U test. The latent phase VAS (p = 0.001), active phase VAS (p < 0.001), and postpartum VAS (p < 0.001) scores of the participants in Group 1 were found to be significantly lower than those of the participants in Group 2, while the satisfaction levels in Group 1 were significantly higher than those in Group 2 (p < 0.001) (Table 4 ). Table 4 VAS scores and satisfaction levels in the groups Group 1 Group 2 p * X ± SD X ± SD Latent phase VAS 4.77 ± 2.18 5.65 ± 2.34 0.001 Active phase VAS 8.62 ± 1.89 9.58 ± .88 < 0.001 Postpartum VAS 2.36 ± 1.65 4.81 ± 2.79 < 0.001 Satisfaction ** 179.53 ± 20.13 152.66 ± 28.39 < 0.001 * Mann-Whitney U test, ** Measured using the Scale for Maternal Satisfaction in Birth. DISCUSSION In the last two decades, the number of medical interventions made during the childbirth process has increased. Many new methods have begun to be implemented with the aim of managing labor in a more controlled manner and achieving better results. However, there are significant discussions regarding how these interventions affect the childbirth experiences of women and how they alter the physiological nature of childbirth ( 1 ). Receiving safe and high-quality pregnancy monitoring and childbirth services is the right of all expectant mothers, and this has been demonstrated in this study to be achievable through mother-friendly approaches. In this study, the effects of mother-friendly practices and respectful obstetric care on maternal and fetal outcomes were evaluated. Accordingly, it was shown that mother-friendly approaches favorably affected maternal satisfaction during childbirth, pain scores, and fetal outcomes. Unlike the case in the literature, in our study, VAS values during the latent phase of labor, active phase of labor, and postpartum period were investigated. In the group where mother-friendly practices were implemented, VAS scores were significantly lower (p < 0.001). In the literature, participants who received mother-friendly care reported less painful, positively remembered, and favorable childbirth stories( 7 , 8 ). It was noted that mothers felt better. However, a quantitative assessment such as VAS scoring was not conducted, and its relationship to satisfaction was not evaluated. Our study is the first to assess the effects of mother-friendly practices on pain-related outcomes measured using VAS. In this study, the initial cervical examinations performed at admission for the participants in the group where mother-friendly practices were implemented revealed significantly higher cervical dilation values than those in the other group (p < 0.001). This was the first indicator of our mother-friendly practices. The admission of the participants to the delivery room was planned close to the active phase of labor to reduce the rate of interventions during childbirth. Additionally, in the group where mother-friendly practices were implemented, the rate of spontaneous rupture of membranes was high, the rate of labor induction was low, the rate of enema application was low, and with these results, the rate of perineal tear occurrence was also found to be low (p < 0.005). These results, consistent with the literature, are considered evidence that interventions during childbirth are less frequently performed in facilities with mother-friendly practices. Mother-friendly approaches result in minimal intervention for mothers and the childbirth process ( 4 , 9 , 10 ). In recent years, care services focusing on continuous physical and emotional support during childbirth and an increase in midwife-led deliveries have been shown to positively affect maternal and neonatal outcomes ( 4 ). These positive results include shorter delivery durations, fewer birth complications, less labor pain, lower rates of labor induction, higher Apgar scores, and greater satisfaction with the childbirth experience ( 9 ). The foundation of the mother-friendly hospital program of the Turkish Ministry of Health also aims to increase midwife care and support during birth, in addition to improving physical conditions. In our study, similar positive effects of mother-friendly practices on maternal and fetal outcomes were observed. In the institution where mother-friendly practices were implemented, the rate of neonatal intensive care unit admissions for newborns was low, and the Apgar scores of these newborns at the 1st and 5th minutes after birth were significantly higher than those of the newborns in the other group (p = 0.022) (Table 2 ). It was shown that mother-friendly approaches and minimal intervention during pregnancy and childbirth directly and positively affected fetal outcomes. In other studies in the literature, it has been emphasized that poor childbirth experiences overlap with poor neonatal outcomes ( 11 – 13 ). Mothers who did not receive Respectful Maternity Care (RMC) during childbirth were found to be three times more likely to experience a complication related to the mother or newborn compared to those who received RMC. The results of the relevant study demonstrated a significant link between disrespectful obstetric care and complications during childbirth for both the mother and the newborn ( 13 ). RMC and the accompanying mother-friendly hospital policies are included in WHO’s 2018 goals and contain different targets for each country ( 1 ). The satisfaction of mothers with childbirth is important for maternal and neonatal health. In the literature, there are many studies evaluating maternal satisfaction and the support provided by healthcare personnel. In a study conducted on the perceptions of healthcare providers regarding how RMC is provided and how it is established and maintained, the importance of care support was underscored yet again( 13 ). In another recent study, it was shown that mother-friendly hospital policies and the comforting interventions of midwives contributed to increased support and comfort provided to women. The importance of ensuring women’s comfort in psychological, environmental, physical, and sociocultural contexts was emphasized ( 11 ). In a recent study conducted in Türkiye, similar to our study, the experiences of women who gave birth in two different hospitals, one mother-friendly and one not, were compared. It was stated that women’s perceptions of respectful obstetric care were quite positive, and the factors affecting these perceptions included giving birth in a mother-friendly hospital and education levels ( 8 ). In the aforementioned study, satisfaction scales were used, as in our study. In the group where mother-friendly practices were implemented, satisfaction rates were found to be high. Unlike our study, satisfaction scales were administered during postpartum follow-up visits. In our study, on the other hand, questionnaires were administered to mothers in the acute postpartum period, and VAS scores were recorded during birth. We believe that this methodology helped us obtain healthier and more reliable results in our study. In a study conducted in Taiwan, the self-reported satisfaction levels of patients (rated from 1 to 10) were used to measure satisfaction with the mother-friendly birth model. In women who received mother-friendly care, similar to our study, lower rates of induction medication and higher satisfaction scores were discovered ( 14 ). In conclusion, the results of our study showed that mother-friendly approaches increased maternal satisfaction during the childbirth process and reduced pain scores. These results revealed that mother-friendly practices not only improve the childbirth experience of women but also contribute positively to maternal and neonatal health. Therefore, supporting and expanding the integration of mother-friendly approaches into the healthcare system is of great importance for improving the quality of obstetric services. Declarations Ethics approval and consent to participate Sakarya University Clinical Research Ethics Committee (Project ID: E-43012747-050.04-438233-43). Consent for publication Not applicable Competing interests The authors declare that they have no competing interests HUY Methodology, Writing - Review & Editing, Supervision AB Data Curation, Resources GÜ Data Curation, Resources MKK Data Curation, Resources ZK Data Curation, Resources Funding Financial disclaimer/conflict of interest: None Author Contribution **MKP:** Conceptualization , Methodology, Validation, Formal analysis, Investigation , Resources , Data Curation , Writing - Original Draft , Visualization, Project administration**HUY:** **Methodology, Writing - Review & Editing, Supervision****AB:** Data Curation, Resources**GÜ:** Data Curation, Resources**MKK:** Data Curation, Resources**ZK:** Data Curation, Resources Acknowledgements Not applicable Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Organization WH. WHO recommendations on intrapartum care for a positive childbirth experience. World Health Organization; 2018. Ribeiro KSC, Magalhães AS, Avelino AHG, Ramos MCS, Santos PWAd, Fonseca RAG, EVENTOS ADVERSOS OBSTÉTRICOS E NEONATAIS E ASSOCIAÇÃO COM OS MODELOS DE ASSISTÊNCIA. : UM ESTUDO COORTE. Texto & Contexto-Enfermagem. 2024;32:e20230079. Göncü Serhatlıoğlu S, Karahan N. Doğum memnuniyeti ve etkileyen faktörler. Uluslararası Hakemli Kadın Hastalıkları ve Anne Çocuk. Sağlığı Dergisi. 2018;15(12):75–91. Fikre R, Gubbels J, Teklesilasie W, Gerards S. Effectiveness of midwifery-led care on pregnancy outcomes in low-and middle-income countries: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):386. Okuyan YC, Bolsoy N, Cetinkaya A. Exploring birth experience of mothers, based on comfort theory. JPMA J Pakistan Med Association. 2024;74(9):1623–9. Güngör İ. Doğumda anne memnuniyetini değerlendirme ölçeğinin geliştirilmesi. İstanbul: İstanbul Üniversitesi Sağlık Bilimleri Enstitüsü Doktora Tezi; 2009. Bilgin Z. Anne dostu hastane modeli ve annelerin doğum memnuniyetleri. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi. Elektronik Dergisi. 2022;15(3):279–88. Dağlı E, Aktaş Reyhan F, Uncu B. Women's Lives and Birth Experiences Are Important! Evaluation of Women's Perceptions of Respectful Maternal Care: The Mother-Friendly Hospital Difference. J Eval Clin Pract. 2025;31(1):e14316. Shahbazi Sighaldeh S, Eskandari E, Khosravi S, Ebrahimi E, Haghani S, Shateranni F. Comparison of maternal and neonatal outcomes of midwifery-led care with routine midwifery care: a retrospective cohort study. BMC Nurs. 2025;24(1):158. Lunda P, Minnie CS, Benadé P. Women’s experiences of continuous support during childbirth: a meta-synthesis. BMC Pregnancy Childbirth. 2018;18(1):167. Muhayimana A, Kearns I. Healthcare providers’ perspectives on sustaining respectful maternity care appreciated by mothers in five hospitals of Rwanda. BMC Nurs. 2024;23(1):442. Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth. Boston: USAID-traction project, Harvard school of public health. 2010;3. Yohannes E, Moti G, Gelan G, Creedy DK, Gabriel L, Hastie C. Impact of disrespectful maternity care on childbirth complications: a multicentre cross-sectional study in Ethiopia. BMC Pregnancy Childbirth. 2024;24(1):380. Li Y-P, Yeh C-H, Lin S-Y, Chen T-C, Yang Y-L, Lee C-N, et al. A proposed mother-friendly childbirth model for Taiwanese women, the implementation and satisfaction survey. Taiwan J Obstet Gynecol. 2015;54(6):731–6. Republic of Turkey, Ministry of Health, General Directorate of Public Health Department of Women and Reproductive, Health. https://hsgm.saglik.gov.tr/tr/programlar-2/anne-dostu-hastane-programi.html Accessed: October 8, 2025. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Apr, 2026 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 25 Nov, 2025 Reviews received at journal 24 Nov, 2025 Reviews received at journal 19 Nov, 2025 Reviewers agreed at journal 12 Nov, 2025 Reviewers agreed at journal 12 Nov, 2025 Reviewers invited by journal 11 Nov, 2025 Editor invited by journal 05 Nov, 2025 Editor assigned by journal 09 Oct, 2025 Submission checks completed at journal 09 Oct, 2025 First submitted to journal 08 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-7810597","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547715986,"identity":"09c53812-8244-4ada-b637-e5a68a0b6e81","order_by":0,"name":"Merve Keskin Paker","email":"","orcid":"","institution":"Sakarya Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Merve","middleName":"Keskin","lastName":"Paker","suffix":""},{"id":547715987,"identity":"7b052d6b-07b1-4077-a13b-9085a5b4bae2","order_by":1,"name":"Ayşe Beyaz","email":"","orcid":"","institution":"Ümraniye Eğitim ve Araştırma 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18:39:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7810597/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7810597/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-026-09143-9","type":"published","date":"2026-04-27T15:58:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96504621,"identity":"8dfdfee2-0377-48d4-91f5-00525e3f87c4","added_by":"auto","created_at":"2025-11-22 02:29:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67476,"visible":true,"origin":"","legend":"","description":"","filename":"08.10.2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7810597/v1/8f02c3090bc06323dd0ff74c.docx"},{"id":96504622,"identity":"546ea0e1-428e-4203-b698-9f68c4c92e6f","added_by":"auto","created_at":"2025-11-22 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02:29:44","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85356,"visible":true,"origin":"","legend":"","description":"","filename":"b270ddc9770b479bb177a54fe4046ccd1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7810597/v1/1f841d04b3bd9bfcb371f757.xml"},{"id":96603804,"identity":"f6413328-4550-42e6-a345-d1b88bfc2ee6","added_by":"auto","created_at":"2025-11-24 09:11:35","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99276,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7810597/v1/07fb08717137a6e98f42c33c.html"},{"id":108437938,"identity":"76fce71c-de2c-4d2b-82c4-fd19f5de9cb2","added_by":"auto","created_at":"2026-05-04 16:04:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":360703,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7810597/v1/cfa0e07a-8db9-4051-984a-d4b23678fb15.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effects Of Mother-Friendly Practices On Maternal And Fetal Outcomes: A Multicenter Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eChildbirth has been perceived differently across many cultures throughout history, and various care and monitoring practices have been implemented. In recent years, the shift of childbirth from a physiological process to a more medically intervened domain has significantly affected women\u0026rsquo;s childbirth experiences. This shift may jeopardize the rights of women to make decisions regarding childbirth and their opportunity to experience this process naturally (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eToday, the main goal in obstetric practice is to ensure that labor occurs under appropriate conditions with minimal intervention and in a normal manner (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It has begun to be accepted that from the beginning of pregnancy until postpartum discharge, non-evidence-based medical interventions should be avoided, necessary interventions should be applied only when required, and the process should progress in its natural physiology (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSupportive care and professional support during labor assist the woman\u0026rsquo;s sense of control and her efforts to cope with labor pain. Supportive care includes practices such as providing physical and emotional support and delivering information. Previous studies have shown that supportive care during labor positively affects maternal and infant outcomes and reduces interventions during labor. Therefore, patient satisfaction related to childbirth is considered an indicator of the quality of obstetric care (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo increase satisfaction levels related to childbirth, it is recommended that mothers be supported physically and psychologically by midwives during labor. Additionally, respecting privacy, early skin-to-skin contact, and the presence of a companion who makes the mother feel comfortable are necessary for a pleasant and comfortable childbirth experience (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn recent years, the relationship between poor quality of care and negative maternal outcomes has been emphasized globally. The World Health Organization (WHO) has published a guide and various recommendations to address labor management in response to the needs of countries. With this guide published by WHO in 2018, respectful maternity care, which forms the basis of labor management, aims to increase childbirth satisfaction and fundamentally protect maternal and newborn health. The importance of providing respectful and supportive care to women during labor is emphasized (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Receiving safe and high-quality pregnancy monitoring and childbirth services is the right of all expectant mothers.\u003c/p\u003e\u003cp\u003eThe strategy developed by the International Federation of Gynecology and Obstetrics (FIGO) and WHO in response to these issues includes the \u0026ldquo;Mother- and Baby-Friendly Birthing Facilities Initiative\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In this context, the concept of the \u0026ldquo;mother-friendly hospital\u0026rdquo; is a program that will improve and further the quality of services provided for pregnancy and childbirth. In T\u0026uuml;rkiye, the foundations of the \u0026ldquo;mother-friendly hospital\u0026rdquo; approach were first laid by the Turkish Ministry of Health in 2011, and the \u0026ldquo;mother-friendly hospital program\u0026rdquo; was published. The aim of the program is to increase the quality and quantity of maternal health services and ensure that expectant mothers have access to safe and high-quality obstetric services. In the mother-, baby-, and family-friendly model, the establishment of single-person \u0026ldquo;Birthing Units\u0026rdquo; based on privacy is essential. The goal is to encourage vaginal birth and reduce intervention rates. With a suitable companion, participants should feel comfortable, as if in a home environment, and be provided with freedom of movement (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Today, the number of Mother-Friendly Hospitals across T\u0026uuml;rkiye has reached 183. The Obstetrics Clinics of Sakarya Research and Training Hospital received the title of Mother-Friendly Hospital on 4 October 2023.\u003c/p\u003e\u003cp\u003eIn this study, it was aimed to evaluate the effects of mother-friendly hospital criteria on pain scores during labor, maternal satisfaction, and maternal and fetal outcomes between two institutions, one where mother-friendly criteria were implemented and one where they were not.\u003c/p\u003e"},{"header":"MATERIAL AND METHOD","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEthical Procedure\u003c/h2\u003e\u003cp\u003eThis study was planned as a prospective case-control study. All participants were informed about the content of the study, and consent forms were obtained. The study protocol was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Sakarya University Clinical Research Ethics Committee (Project ID: E-43012747-050.04-438233-43).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePopulation:\u003c/h3\u003e\n\u003cp\u003eThe Obstetrics Clinics of Sakarya Research and Training Hospital, where the study was conducted, received the title of Mother-Friendly Hospital on 4 October 2023. According to this program, physical conditions were improved, and the operations of the delivery team were standardized. As a result, patients experience a childbirth process in single-person rooms, accompanied by a companion, and supported by midwives with minimal intervention. Since the Obstetrics and Gynecology Clinics of \u0026Uuml;mraniye Research and Training Hospital have not yet received the title of Mother-Friendly Hospital, standard care and monitoring services are provided in their delivery rooms.\u003c/p\u003e\u003cp\u003eBetween February 2025 and June 2025, a total of 281 women who gave birth at term were included in the study. Women over the age of 45, those with multiple pregnancies, maternal type 1 and type 2 diabetes mellitus or gestational diabetes, chronic hypertension, preeclampsia, connective tissue disease, chronic kidney and liver disease, and hematological diseases were not included in the study. Pregnancies with preterm birth (gestational age\u0026thinsp;\u0026lt;\u0026thinsp;37 weeks), small-for-gestational age infants (birth weight\u0026thinsp;\u0026lt;\u0026thinsp;2 SD), neonatal asphyxia (Apgar score\u0026thinsp;\u0026lt;\u0026thinsp;7 at the first and fifth minutes), malformations, chromosomal diseases, and congenital infections were excluded from the study.\u003c/p\u003e\u003cp\u003eAge, education level, gestational week at admission to the delivery room, cervical dilation, childbirth education status, interventions during labor (enema, episiotomy, vacuum, forceps), and non-pharmacological methods applied were recorded. Pain scores during labor were measured using the Visual Analog Scale (VAS), and mode of delivery, postpartum hemorrhage (PPH) status, and duration of stay in the delivery room were recorded. For fetal outcomes, fetal weight at birth, Apgar scores, and neonatal intensive care unit requirements were recorded. The Scale for Measuring Maternal Satisfaction in Birth was completed by the participants in the first postpartum hour (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eVisual Analog Scale (VAS):\u003c/h3\u003e\n\u003cp\u003eVAS is used to assess the intensity of pain. An eleven-point scale was used during the assessment, where \u0026ldquo;0\u0026rdquo; represented \u0026ldquo;no pain\u0026rdquo;, and \u0026ldquo;10\u0026rdquo; represented \u0026ldquo;the most severe pain imaginable.\u0026rdquo; VAS is evaluated on a 100 mm horizontal line. Participants are told that the left end of the scale means \u0026ldquo;no pain\u0026rdquo; and that the right end means \u0026ldquo;the most severe pain imaginable.\u0026rdquo; It allows pain measurement based on the participant\u0026rsquo;s own statement, categorized from no pain to severe pain at specific intervals. Pain scores during the latent and active phases of labor and at different postpartum times were recorded. Based on the amount of cervical dilation, the latent phase was defined as 0\u0026ndash;6 cm, and the active phase was defined as 6\u0026ndash;10 cm.\u003c/p\u003e\n\u003ch3\u003eScale for Measuring Maternal Satisfaction in Birth:\u003c/h3\u003e\n\u003cp\u003eThe scale consists of 43 items and 10 dimensions. The dimensions of the scale are Perception of the Healthcare Team, Nursing Care During Labor, Comforting, Participation in Decisions and Information, Meeting the Baby, Postpartum Care, Hospital Room, Hospital Facilities, Respect for Privacy, and Meeting Expectations. The Cronbach\u0026rsquo;s alpha internal consistency coefficient of the scale was found to be 0.91. The scale can be completed by mothers themselves. Items are scored on a five-point Likert-type scale according to the respondent\u0026rsquo;s degree of agreement (1-Strongly disagree, 2-Partially agree, 3-Neutral, 4-Agree, and 5-Strongly agree). Thirteen items (7, 8, 9, 10, 19, 20, 21, 22, 35, 36, 38, 41, and 42) are scored in reverse. To calculate scale scores, the items that are scored in reverse are first converted. In reversing item scores, the response options \u0026ldquo;1-Strongly disagree, 2-Partially agree, 3-Neutral, 4-Agree, and 5-Strongly agree\u0026rdquo; become \u0026ldquo;5-Strongly disagree, 4-Partially agree, 3-Neutral, 2-Agree, and 1-Strongly agree.\u0026rdquo;\u003c/p\u003e\u003cp\u003eAfter reversing the scores of these items, the sum of the scores of all items in the scale gives the \u0026ldquo;total scale score.\u0026rdquo; The sum of the items forming each dimension can be used as the \u0026ldquo;total dimension score.\u0026rdquo; The total raw score ranges from 43 to 215. Higher total scale scores indicate higher levels of satisfaction of mothers with the care received during vaginal birth in the hospital. The cut-off score calculated for the Scale for Measuring Maternal Satisfaction in Birth was determined as 150.5 (\u0026ge;\u0026thinsp;150.5 indicates high satisfaction levels, \u0026lt;\u0026thinsp;150.5 indicates low satisfaction levels) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe analyses were conducted using the SPSS (Statistical Package for the Social Sciences; SPSS Inc., Chicago, IL) version 22 software package. Descriptive data are presented as n and % for the categorical variables and as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (X\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) for the continuous variables. Pearson\u0026rsquo;s chi-squared tests were applied for the comparisons of the categorical variables between groups. The normality of the distribution of the continuous variables was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparisons of two groups, and the Kruskal-Wallis test was used for comparisons of more than two groups. The relationships between variables were evaluated using Spearman\u0026rsquo;s correlation analysis. A statistical significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was accepted in all analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 281 participants who gave birth at term in the delivery rooms of Sakarya Research and Training Hospital (Group 1, n\u0026thinsp;=\u0026thinsp;136), where mother-friendly approaches were implemented, and \u0026Uuml;mraniye Research and Training Hospital (Group 2, n\u0026thinsp;=\u0026thinsp;145), where mother-friendly approaches were not implemented, were included in the study.\u003c/p\u003e\u003cp\u003eNo statistically significant differences were found between Group 1 and Group 2 in terms of age, body mass index (BMI), education level, employment status, gestational week, duration of stay in the delivery room, and postpartum hemorrhage (PPH) rates (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eThe initial cervical examinations performed at admission for the participants in Group 1 revealed significantly higher cervical dilation values than those in Group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eThe rate of receiving childbirth-related education before delivery among the participants in Group 1 (31.6%) was significantly lower than the rate in Group 2 (53.1%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e25.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e26.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeight\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e161.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e161.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.600\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e76.82\u0026thinsp;\u0026plusmn;\u0026thinsp;13.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e78.05\u0026thinsp;\u0026plusmn;\u0026thinsp;14.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.461\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e29.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e29.87\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.391\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGestational week\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e39.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e39.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.790\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCervical dilation at admission (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school or below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.833\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.689\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eReads sources about childbirth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e38.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eReceived education about childbirth before giving birth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003ePostpartum hemorrhage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eBMI: Body Mass Index\u003c/em\u003e, \u003csup\u003e*\u003c/sup\u003eMann-Whitney U test, \u003csup\u003e**\u003c/sup\u003eChi-squared test.\u003c/p\u003e\u003cp\u003eThe rate of neonatal intensive care unit admissions among the participants in Group 1 (2.9%) was significantly lower than that of those in Group 2 (9.7%) (p\u0026thinsp;=\u0026thinsp;0.022). The Apgar scores at the 1st minute (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 5th minute (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for the newborns of the participants in Group 1 were significantly higher than those in Group 2 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It was shown that mother-friendly approaches and minimal intervention during pregnancy and childbirth directly and positively affected fetal outcomes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFetal outcomes in the groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eNICU admission\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e90.3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight of baby\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e3280.00\u0026thinsp;\u0026plusmn;\u0026thinsp;373.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e3224.52\u0026thinsp;\u0026plusmn;\u0026thinsp;455.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.459\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e1st min. Apgar\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e8.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e8.04\u0026thinsp;\u0026plusmn;\u0026thinsp;.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e5th min. Apgar\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e9.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e9.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eNICU: Neonatal Intensive Care Unit\u003c/em\u003e, \u003csup\u003e*\u003c/sup\u003eChi-squared test, \u003csup\u003e**\u003c/sup\u003eMann-Whitney U test.\u003c/p\u003e\u003cp\u003eAmong the participants in Group 1, the rupture of the membranes occurred at home in 30.9%, spontaneously in 41.2%, and via amniotomy in 27.9%, whereas in Group 2, ruptures occurred at home in 33.1%, spontaneously in 24.1%, and via amniotomy in 42.8%. A statistically significant difference was observed between the groups (p\u0026thinsp;=\u0026thinsp;0.005) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe rate of labor induction among the participants in Group 1 (49.3%) was significantly lower than that of those in Group 2 (71%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The rate of enema application among the participants in Group 1 (0.7%) was significantly lower than the rate in Group 2 (5.5%) (p\u0026thinsp;=\u0026thinsp;0.037) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe rate of perineal tear occurrence among the participants in Group 1 (24.6%) was significantly lower than the rate in Group 2 (39.4%) (p\u0026thinsp;=\u0026thinsp;0.009). The rate of Kristeller maneuver application among the participants in Group 1 (13.3%) was significantly lower than the rate in Group 2 (30.4%) (p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong the participants in Group 1, 8.1% breastfed immediately, 42.6% breastfed within half an hour, 44.9% breastfed within one hour, 2.9% breastfed within two hours, and 1.5% did not breastfeed. In Group 2, 4.8% breastfed immediately, 35.9% breastfed within half an hour, 34.5% breastfed within one hour, 17.9% breastfed within two hours, and 6.9% did not breastfeed. A statistically significant difference was observed between the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInterventions applied in the groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMembrane rupture\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpontaneous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmniotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLabor induction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eEnema\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e94.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003ePerineal tear\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e60.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKristeller maneuver\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eBreastfeeding time\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImmediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithin \u0026frac12; h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithin 1 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithin 2 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo feeding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003ePain alleviation methods\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of stay in delivery room\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e764.85\u0026thinsp;\u0026plusmn;\u0026thinsp;540.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e886.51\u0026thinsp;\u0026plusmn;\u0026thinsp;865.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.989\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eChi-squared test, \u003csup\u003e**\u003c/sup\u003eMann-Whitney U test.\u003c/p\u003e\u003cp\u003eThe latent phase VAS (p\u0026thinsp;=\u0026thinsp;0.001), active phase VAS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and postpartum VAS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) scores of the participants in Group 1 were found to be significantly lower than those of the participants in Group 2, while the satisfaction levels in Group 1 were significantly higher than those in Group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVAS scores and satisfaction levels in the groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eX\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLatent phase VAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eActive phase VAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.58\u0026thinsp;\u0026plusmn;\u0026thinsp;.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostpartum VAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSatisfaction\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e179.53\u0026thinsp;\u0026plusmn;\u0026thinsp;20.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e152.66\u0026thinsp;\u0026plusmn;\u0026thinsp;28.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eMann-Whitney U test, \u003csup\u003e**\u003c/sup\u003eMeasured using the Scale for Maternal Satisfaction in Birth.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn the last two decades, the number of medical interventions made during the childbirth process has increased. Many new methods have begun to be implemented with the aim of managing labor in a more controlled manner and achieving better results. However, there are significant discussions regarding how these interventions affect the childbirth experiences of women and how they alter the physiological nature of childbirth (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eReceiving safe and high-quality pregnancy monitoring and childbirth services is the right of all expectant mothers, and this has been demonstrated in this study to be achievable through mother-friendly approaches. In this study, the effects of mother-friendly practices and respectful obstetric care on maternal and fetal outcomes were evaluated. Accordingly, it was shown that mother-friendly approaches favorably affected maternal satisfaction during childbirth, pain scores, and fetal outcomes.\u003c/p\u003e\u003cp\u003eUnlike the case in the literature, in our study, VAS values during the latent phase of labor, active phase of labor, and postpartum period were investigated. In the group where mother-friendly practices were implemented, VAS scores were significantly lower (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the literature, participants who received mother-friendly care reported less painful, positively remembered, and favorable childbirth stories(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It was noted that mothers felt better. However, a quantitative assessment such as VAS scoring was not conducted, and its relationship to satisfaction was not evaluated. Our study is the first to assess the effects of mother-friendly practices on pain-related outcomes measured using VAS.\u003c/p\u003e\u003cp\u003eIn this study, the initial cervical examinations performed at admission for the participants in the group where mother-friendly practices were implemented revealed significantly higher cervical dilation values than those in the other group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This was the first indicator of our mother-friendly practices. The admission of the participants to the delivery room was planned close to the active phase of labor to reduce the rate of interventions during childbirth. Additionally, in the group where mother-friendly practices were implemented, the rate of spontaneous rupture of membranes was high, the rate of labor induction was low, the rate of enema application was low, and with these results, the rate of perineal tear occurrence was also found to be low (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005). These results, consistent with the literature, are considered evidence that interventions during childbirth are less frequently performed in facilities with mother-friendly practices. Mother-friendly approaches result in minimal intervention for mothers and the childbirth process (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn recent years, care services focusing on continuous physical and emotional support during childbirth and an increase in midwife-led deliveries have been shown to positively affect maternal and neonatal outcomes (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These positive results include shorter delivery durations, fewer birth complications, less labor pain, lower rates of labor induction, higher Apgar scores, and greater satisfaction with the childbirth experience (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The foundation of the mother-friendly hospital program of the Turkish Ministry of Health also aims to increase midwife care and support during birth, in addition to improving physical conditions. In our study, similar positive effects of mother-friendly practices on maternal and fetal outcomes were observed.\u003c/p\u003e\u003cp\u003eIn the institution where mother-friendly practices were implemented, the rate of neonatal intensive care unit admissions for newborns was low, and the Apgar scores of these newborns at the 1st and 5th minutes after birth were significantly higher than those of the newborns in the other group (p\u0026thinsp;=\u0026thinsp;0.022) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It was shown that mother-friendly approaches and minimal intervention during pregnancy and childbirth directly and positively affected fetal outcomes. In other studies in the literature, it has been emphasized that poor childbirth experiences overlap with poor neonatal outcomes (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Mothers who did not receive Respectful Maternity Care (RMC) during childbirth were found to be three times more likely to experience a complication related to the mother or newborn compared to those who received RMC. The results of the relevant study demonstrated a significant link between disrespectful obstetric care and complications during childbirth for both the mother and the newborn (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRMC and the accompanying mother-friendly hospital policies are included in WHO\u0026rsquo;s 2018 goals and contain different targets for each country (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The satisfaction of mothers with childbirth is important for maternal and neonatal health. In the literature, there are many studies evaluating maternal satisfaction and the support provided by healthcare personnel. In a study conducted on the perceptions of healthcare providers regarding how RMC is provided and how it is established and maintained, the importance of care support was underscored yet again(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e In another recent study, it was shown that mother-friendly hospital policies and the comforting interventions of midwives contributed to increased support and comfort provided to women. The importance of ensuring women\u0026rsquo;s comfort in psychological, environmental, physical, and sociocultural contexts was emphasized (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a recent study conducted in T\u0026uuml;rkiye, similar to our study, the experiences of women who gave birth in two different hospitals, one mother-friendly and one not, were compared. It was stated that women\u0026rsquo;s perceptions of respectful obstetric care were quite positive, and the factors affecting these perceptions included giving birth in a mother-friendly hospital and education levels (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In the aforementioned study, satisfaction scales were used, as in our study. In the group where mother-friendly practices were implemented, satisfaction rates were found to be high. Unlike our study, satisfaction scales were administered during postpartum follow-up visits. In our study, on the other hand, questionnaires were administered to mothers in the acute postpartum period, and VAS scores were recorded during birth. We believe that this methodology helped us obtain healthier and more reliable results in our study.\u003c/p\u003e\u003cp\u003eIn a study conducted in Taiwan, the self-reported satisfaction levels of patients (rated from 1 to 10) were used to measure satisfaction with the mother-friendly birth model. In women who received mother-friendly care, similar to our study, lower rates of induction medication and higher satisfaction scores were discovered (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn conclusion, the results of our study showed that mother-friendly approaches increased maternal satisfaction during the childbirth process and reduced pain scores. These results revealed that mother-friendly practices not only improve the childbirth experience of women but also contribute positively to maternal and neonatal health. Therefore, supporting and expanding the integration of mother-friendly approaches into the healthcare system is of great importance for improving the quality of obstetric services.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003eSakarya University Clinical Research Ethics Committee (Project ID: E-43012747-050.04-438233-43).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eHUY\u003c/h2\u003e\u003cp\u003eMethodology, Writing - Review \u0026amp; Editing, Supervision\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAB\u003c/strong\u003e\u003cp\u003eData Curation, Resources\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eG\u0026Uuml;\u003c/strong\u003e\u003cp\u003eData Curation, Resources\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMKK\u003c/strong\u003e\u003cp\u003eData Curation, Resources\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eZK\u003c/strong\u003e\u003cp\u003eData Curation, Resources\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eFinancial disclaimer/conflict of interest: None\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e**MKP:** Conceptualization , Methodology, Validation, Formal analysis, Investigation , Resources , Data Curation , Writing - Original Draft , Visualization, Project administration**HUY:** **Methodology, Writing - Review \u0026amp;amp; Editing, Supervision****AB:** Data Curation, Resources**G\u0026Uuml;:** Data Curation, Resources**MKK:** Data Curation, Resources**ZK:** Data Curation, Resources\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. WHO recommendations on intrapartum care for a positive childbirth experience. World Health Organization; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRibeiro KSC, Magalh\u0026atilde;es AS, Avelino AHG, Ramos MCS, Santos PWAd, Fonseca RAG, EVENTOS ADVERSOS OBST\u0026Eacute;TRICOS E NEONATAIS E ASSOCIA\u0026Ccedil;\u0026Atilde;O COM OS MODELOS DE ASSIST\u0026Ecirc;NCIA. : UM ESTUDO COORTE. Texto \u0026amp; Contexto-Enfermagem. 2024;32:e20230079.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026ouml;nc\u0026uuml; Serhatlıoğlu S, Karahan N. Doğum memnuniyeti ve etkileyen fakt\u0026ouml;rler. Uluslararası Hakemli Kadın Hastalıkları ve Anne \u0026Ccedil;ocuk. Sağlığı Dergisi. 2018;15(12):75\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFikre R, Gubbels J, Teklesilasie W, Gerards S. Effectiveness of midwifery-led care on pregnancy outcomes in low-and middle-income countries: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):386.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkuyan YC, Bolsoy N, Cetinkaya A. Exploring birth experience of mothers, based on comfort theory. JPMA J Pakistan Med Association. 2024;74(9):1623\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026uuml;ng\u0026ouml;r İ. Doğumda anne memnuniyetini değerlendirme \u0026ouml;l\u0026ccedil;eğinin geliştirilmesi. İstanbul: İstanbul \u0026Uuml;niversitesi Sağlık Bilimleri Enstit\u0026uuml;s\u0026uuml; Doktora Tezi; 2009.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBilgin Z. Anne dostu hastane modeli ve annelerin doğum memnuniyetleri. Dokuz Eyl\u0026uuml;l \u0026Uuml;niversitesi Hemşirelik Fak\u0026uuml;ltesi. Elektronik Dergisi. 2022;15(3):279\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDağlı E, Aktaş Reyhan F, Uncu B. Women's Lives and Birth Experiences Are Important! Evaluation of Women's Perceptions of Respectful Maternal Care: The Mother-Friendly Hospital Difference. J Eval Clin Pract. 2025;31(1):e14316.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShahbazi Sighaldeh S, Eskandari E, Khosravi S, Ebrahimi E, Haghani S, Shateranni F. Comparison of maternal and neonatal outcomes of midwifery-led care with routine midwifery care: a retrospective cohort study. BMC Nurs. 2025;24(1):158.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLunda P, Minnie CS, Benad\u0026eacute; P. Women\u0026rsquo;s experiences of continuous support during childbirth: a meta-synthesis. BMC Pregnancy Childbirth. 2018;18(1):167.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuhayimana A, Kearns I. Healthcare providers\u0026rsquo; perspectives on sustaining respectful maternity care appreciated by mothers in five hospitals of Rwanda. BMC Nurs. 2024;23(1):442.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth. Boston: USAID-traction project, Harvard school of public health. 2010;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYohannes E, Moti G, Gelan G, Creedy DK, Gabriel L, Hastie C. Impact of disrespectful maternity care on childbirth complications: a multicentre cross-sectional study in Ethiopia. BMC Pregnancy Childbirth. 2024;24(1):380.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Y-P, Yeh C-H, Lin S-Y, Chen T-C, Yang Y-L, Lee C-N, et al. A proposed mother-friendly childbirth model for Taiwanese women, the implementation and satisfaction survey. Taiwan J Obstet Gynecol. 2015;54(6):731\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRepublic of Turkey, Ministry of Health, General Directorate of Public Health Department of Women and Reproductive, Health. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://hsgm.saglik.gov.tr/tr/programlar-2/anne-dostu-hastane-programi.html\u003c/span\u003e\u003cspan address=\"https://hsgm.saglik.gov.tr/tr/programlar-2/anne-dostu-hastane-programi.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed: October 8, 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mother-friendly, Maternal satisfaction, Maternal outcomes, Fetal outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7810597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7810597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction and Objective:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFrom early pregnancy to postpartum discharge, avoiding unnecessary non-evidence-based interventions and supporting natural physiological processes form the basis of the \u0026ldquo;mother-friendly hospital\u0026rdquo; model, a new program designed to enhance care quality. This study evaluated the impact of implementing mother-friendly hospital criteria on pain during labor, maternal satisfaction, and maternal and fetal outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMaterials and Methods:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis prospective study included women with term pregnancies who delivered between February and June 2025 at Sakarya Research and Training Hospital (Group 1, with mother-friendly practices) and \u0026Uuml;mraniye Research and Training Hospital (Group 2, without such practices). Exclusion criteria were maternal age\u0026thinsp;\u0026gt;\u0026thinsp;45 years, chronic systemic disease (e.g., diabetes, hypertension, renal or hepatic disease), preeclampsia or gestational diabetes, premature rupture of membranes\u0026thinsp;\u0026gt;\u0026thinsp;12 hours with chorioamnionitis findings, preterm birth (\u0026lt;\u0026thinsp;37 weeks), and small-for-gestational-age infants (\u0026lt;\u0026thinsp;2 SD). Maternal characteristics (age, education, cervical dilation, gestational week, childbirth education, delivery interventions, postpartum hemorrhage, non-pharmacological methods, duration of labor), pain levels using the Visual Analog Scale (VAS), and fetal outcomes (birth weight, Apgar scores, neonatal intensive care unit [NICU] admission) were recorded. Maternal satisfaction was assessed in the first postpartum hour using the Birth Satisfaction Scale.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 281 women were enrolled (Group 1: 136, Group 2: 145). No significant differences were found between groups regarding age, body mass index, education, employment status, gestational week, labor duration, or postpartum hemorrhage (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Latent phase, active phase, and postpartum VAS scores were significantly lower in Group 1 compared with Group 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Maternal satisfaction scores were significantly higher in Group 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). NICU admission was significantly less frequent in Group 1 (2.9% vs. 9.7%, p\u0026thinsp;=\u0026thinsp;0.022). First- and fifth-minute Apgar scores were also higher in Group 1 newborns (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMother-friendly hospital practices, emphasizing minimal intervention and physiologic support, significantly reduce pain during labor, increase maternal satisfaction, and improve neonatal outcomes. Ensuring safe, high-quality, and mother-centered maternity care is a fundamental right for all women and can be achieved through implementation of mother-friendly approaches.\u003c/p\u003e","manuscriptTitle":"The Effects Of Mother-Friendly Practices On Maternal And Fetal Outcomes: A Multicenter Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-22 02:29:39","doi":"10.21203/rs.3.rs-7810597/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-25T08:19:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T19:01:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T18:41:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86107641357319325841200177074666576538","date":"2025-11-12T10:40:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334385002051130431842272762574430182407","date":"2025-11-12T09:54:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T19:46:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-05T09:48:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-10T03:20:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T03:19:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-10-08T18:35:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2194d311-c839-4a39-9422-d08ab562999c","owner":[],"postedDate":"November 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:04:05+00:00","versionOfRecord":{"articleIdentity":"rs-7810597","link":"https://doi.org/10.1186/s12884-026-09143-9","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2026-04-27 15:58:21","publishedOnDateReadable":"April 27th, 2026"},"versionCreatedAt":"2025-11-22 02:29:39","video":"","vorDoi":"10.1186/s12884-026-09143-9","vorDoiUrl":"https://doi.org/10.1186/s12884-026-09143-9","workflowStages":[]},"version":"v1","identity":"rs-7810597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7810597","identity":"rs-7810597","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}