Cervical Balloon Induction in LDRP Unit: Effects on Maternal and Neonatal Outcomes for Primiparous Women

Cervical Balloon Induction in LDRP Unit: Effects on Maternal and Neonatal Outcomes for Primiparous Women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cervical Balloon Induction in LDRP Unit: Effects on Maternal and Neonatal Outcomes for Primiparous Women Chunfeng Gao, Qiang Ma, Jinhua Dong, Fang Chen, Qingqing Ni This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4166038/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : To compare the delivery outcomes and childbirth experiences of primiparous women using double-balloon catheters to induce labor in LDRP (labor waiting, delivery and postpartum recovery) unit and in ordinary delivery room. Methods: 160 cases of primiparous women undergoing induced labor with double-balloon catheters in Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University between January 2022 and October 2022 were selected as the study group, either in LDRP unit or in ordinary delivery room. Age, gestational week, BMI, induced labor outcome, and blood loss at 2 hours postpartum were evaluated and compared between the two groups. Three days after delivery, the women assessed their childbirth experience using the Chinese version of Childbirth Experience Questionnaire (CEQ-C). The data was analyzed utilizing IBM SPSS Statistics. Results: Women in the LDRP group experienced shorter time of total labor stage (333.16 min vs 434.88 min, P < 0.01) and first stage of labor (262.87 min vs 360.34 min, P < 0.01). Incidence of intrapartum fever in the LDRP group were lower than those in the control group (P 0.05). Additionally, rates of postpartum infection, neonatal admissions, 5min-Apgar scores, and indications for CS were similar in the two groups (P > 0.05). The mean total CEQ-C score for women in LDRP was 3.48 (SD 0.25). In “Own capacity it was 3.38 (SD 0.40), in “Professional support” it was 3.91 (SD 0.19), in “Perceived safety” it was 3.16 (SD 0.51), and in “Participation” it was 3.22 (SD 0.56). When comparing women in ordinary room, differences were detectable (p < 0.01). Conclusion LDRP can improve the outcome of cervical balloon induction and enhance the experience of childbirth. LDRP cervical balloon induction experience of childbirth Background In many cultures, childbirth is seen as a significant stress event for mothers, which can greatly influence their physical and mental well-being. Research has shown that the experience of childbirth can have varying impacts on the mother's physiology, psychology, and even the dynamics of the entire family[ 1 , 2 ]. A negative childbirth experience can greatly affect a mother's self-esteem, self-efficacy, and overall quality of life postpartum. This can ultimately lead to a higher incidence of postpartum depression[ 3 ]. Many believe that the childbirth experience is just as important as the outcome of the delivery itself, as it can greatly impact a woman's bodily and psychological health. According to a study[ 4 ] conducted by Zhu et al. (2020), the childbirth experience scores of Chinese mothers were found to be generally lower than those of other Western countries, such as Sweden, the United Kingdom, and Spain, based on delivery time. There is a recommendation for the enhancement of the delivery experience among Chinese mothers. In fact, it is now being recognized as a crucial indicator for measuring the quality of obstetric care[ 5 ]. With the development of China's medical and health services, including better access to prenatal care and advancements in technology, the maternal mortality rate has significantly decreased. As a result, improving the delivery experience of pregnant women has become a top priority in maternal and child health care[ 6 ]. To ensure positive childbirth experiences, it is necessary to provide women with respectful and evidence-based intrapartum care. Consequently, many medical facilities have implemented a unit in their hospitals and birthing centers known as LDRP (an abbreviation for labor, delivery, recovery, and postpartum) covering all stages from labor preparation to postpartum recovery, with the purpose of providing family-oriented care. Research[ 7 ] has shown that women and their families have a more enjoyable and less stressful birth experience when they have the opportunity to give birth in a room designed to feel like a home. Conversely, a qualitative study suggested that a deficiency of family support during childbirth had a negative effect on women's mental health during childbirth[ 8 ]. The LDRP unit boasts a calm and inviting environment, allowing mothers and their families to fully immerse themselves in the birth experience. Moreover, the facility offers some specialized care for any potential complications that may occur during labor, ensuring the safety and well-being of both the mother and her baby. Due to certain medical conditions, such as gestational diabetes or preeclampsia, some pregnant women in the third trimester may need to undergo labor induction. According to recent studies[ 9 ], the induction of labor, especially when cervical ripening is necessary, has been identified as a known risk factor for a negative birth experience. This risk is heightened for nulliparous women, compared to women who have had multiple pregnancies. There are two common methods for initiating cervical ripening - mechanical with a balloon catheter and pharmacological with prostaglandins. Both have been extensively studied and have shown to be safe and effective[ 10 – 12 ]. However, recent research has suggested that the double-balloon catheter may be a safer approach for patients[ 13 – 15 ]. The LDRP delivery model, which is gaining popularity in China for its emphasis on natural delivery, may not be suitable for pregnant women who are at a higher risk for complications. Because the LDRP unit is located further away from the operating room compared to the ordinary delivery room, potentially causing delays in emergency surgeries. Furthermore, due to the added family members, the sterile environment will be compromised and the likelihood of infections will rise. There is limited data on the safety and effectiveness of induced labor in LDRP births, prompting further research and investigation. The purpose of this study was to compare the delivery outcomes and childbirth experiences of primiparous women using double-balloon catheters to induce labor in LDRP and ordinary delivery rooms in order to determine the more effective and comfortable method for mothers and babies. MATERIAL AND METHODS This prospective study was carried out between January 1, 2022, and October 1, 2022 at the Department of Obstetrics, Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University. We included primiparous women with viable singleton term pregnancies undergoing cervical ripening and labor induction by double-balloon catheter. This study was reviewed and approved by the ethics committee of the hospital (ethical approval number: 2020 medical ethics (express)-37) with informed consent obtained from all participating pregnant women and their families. According to the wishes of the pregnant women, the study divided participants into two groups: those admitted to the LDRP unit and those who gave birth in the ordinary delivery room. Participants in the study were nulliparous and in the late stages of pregnancy, between 37 and 41 weeks, with a Bishop score of < 6. Exclusion criteria were carefully considered in order to ensure a homogeneous sample. These criteria included multiple gestation, premature rupture of membranes, placental abruption, fetal distress, previous uterine surgery, chorioamnionitis or active infection of the birth canal, and fetal malformations. During the surgical procedure, the Cook Cervical Ripening Balloon (CCRB) was inserted into the cervical canal using oval forceps. Following this, both the intrauterine and intravaginal balloons were filled with 80 mL of saline solution and left in place for about 12 hours to promote cervical dilation. The next step was that when the cervix reached a Bishop score of ≥ 6, the doctor performed an amniotomy to speed up the labor process. After an hour of waiting, since the mother was not experiencing regular uterine contractions, oxytocin was also administered intravenously to help stimulate them. When the cervix dilated to 2 cm, all pregnant women underwent analgesic delivery to help manage their pain during labor. The following variables were recorded during the study: maternal age, gestational age, gravidity, body mass index, Bishop score, indications for induced labor, hours of labor induction, amount of postpartum bleeding, neonatal 1-5minute score, intrapartum fever (> 38°C), cesarean section, and instrumental delivery situation. Information on the characteristics and delivery outcomes of the study population was retrieved from patient records. After 3 days postpartum before discharge, the multidimensional Chinese version of Childbirth Experience Questionnaire (CEQ-C) was used as the childbirth experience survey method. Four categories within the questionnaire measured aspects of the birth experience: personal proficiency, perceived safety, professional guidance, and involvement. Statistical analyses Data were analyzed using SPSS 26.0 statistical software. Student's t-test was utilized to compare the variations between groups, when appropriate, with findings presented as mean ± SD. The categorical information was presented as either counts or percentages and was assessed through χ2 (Fisher's exact) analysis. A P-value < 0.05 was considered to show statistical significance. RESULTS 160 nulliparous women were recruited for the research. Each group consisted of 80 women, with the LDRP group being the observation group and the ordinary delivery room group being the control group. The two groups had similar clinical baseline parameters, as shown in Table 1 , with no significant differences noted. Table 1 Clinical and demographic characteristics of the study population LDRP (n = 80) Ordinary (n = 80) P-value Maternal age (year) Gestational age (week) Body mass index (kg/m 2 ) Bishop score GBS+ Indications for labor induction Gestational diabetes Intrahepatic cholestasis of pregnancy Preeclampsia or Gestational hypertension Immune system diseases Fetal growth restriction Suspected macrosomia Delayed pregnancy Other reasons 28.05(4.38) 39.54(0.95) 26.86(3.23) 4.91(0.28) 8(10%) 14(18.5%) 2(2.5%) 7(8.75%) 2(2.5%) 7(8.75%) 21(26.25%) 5(6.25%) 22(27.5%) 27.83(3.24) 39.58(0.95) 27.77(3.28) 4.94(0.24) 4(5%) 12(15%) 2(2.5%) 11(13.75%) 7(8.75%) 3(3.75%) 12(15%) 6(7.5%) 27(33.75%) 0.326 0.926 0.077 0.550 0.230 0.668 1.000 0.317 0.170 0.191 0.079 0.755 0.391 Data are given as mean (standard deviation) or n (%). GBS: group B streptococcus; other reasons: subclinical hypothyroidism, mild arrhythmia, pregnant women's requirements, borderline oligohydramnios. The durations of the first stage of labor and total labor in the study group were significantly shorter than those of the control group (for the first stage (262.87 ± 98.60) min vs. (360.34 ± 151.30) min, p = 0.000; for the total labor (333.16 ± 107.11) min vs. (434.88 ± 154.49) min, p = 0.000). There were no significant differences in the length of the second labor. It was found that the incidence of intrapartum fever in the LDRP group was significantly lower than that in the ordinary delivery room group (p<0.05). There was no difference between the two groups in conversion to cesarean section (Table 2 ). Table 2 presents delivery and neonatal outcomes LDRP (n = 80) Ordinary (n = 80) P-value Total stage of labor (min) First stage of labor (min) Second stage of labor (min) Amount of postpartum bleeding (ml) Postpartum hemorrhage Postpartum infection 38°C<Intrapartum fever ≥ 37.5°C Intrapartum fever ≥ 38.0°C Type of delivery Vaginal Instrumental Cesarean section Birth weight (g) Apgar score at 1 min Apgar score at 5 min Admissions to NICU 333.16(107.11) 262.87(98.60) 65.16(33.48) 330.00(148.42) 5(6.25%) 10(12.5%) 11(13.75%) 5(6.25%) 58(72.5%) 10(12.5%) 12(15%) 3372.38(361.54) 9.84(0.46) 9.89(0.32) 2(2.5%) 434.88(154.49) 360.34(151.30) 61.50(34.85) 303.63(76.00) 3(3.75%) 16(20%) 23(28.75%) 18(22.5%) 43(53.75%) 15(18.75%) 22(27.5%) 3362.88(415.65) 9.65(0.62) 9.84(0.37) 6(7.5%) 0.000* 0.000* 0.518 0.886 0.717 0.199 0.002* 0.000* 0.014* 0.276 0.053 0.878 0.007* 0.360 0.277 Data are given as mean (standard deviation) or n (%). NICU: neonatal intensive care unit. * p < 0.05 was considered statistically significant. Operative delivery indications did not vary between the two groups as it was showed in Table 3 . Table 3 Operative delivery in both study groups according to indication LDRP Ordinary P-value Instrumental delivery for risk of fetal distress Instrumental delivery for prolonged expulsive (> 2 h) CS for risk of fetal distress CS for failed induction CS for stagnant labor CS for cephalopelvic disproportion 6/10 (60%) 4 /10(40%) 2/12 (17%) 1/12 (8%) 5/12(42%) 4/12(33%) 11/15(73%) 4/15(27%) 5/22(23%) 5/22 (23%) 6/22(27%) 6/22(27%) 0.667 0.667 1.000 0.389 0.459 0.714 Data are given as n/N (%); Instrumental delivery: forceps or vacuum extraction; CS: cesarean section. There was no significant difference in the carriage rate of group B streptococcus (GBS) between the fever group and the normal temperature group. The fever group experienced a notably extended period of time during the first stage of labor. The normal temperature group showed lower occurrences of instrumental delivery and neonatal intensive care unit (NICU) admission (Table 4 ). Table 4 Outcomes of intrapartum fever Fever(n = 57) normal (n = 103) P-value GBS+ First stage of labor (min) Admissions to NICU Postpartum hemorrhage (ml) CS delivery Instrumental delivery 6(10.53%) 391.90(137.65) 6(10.53%) 326.32(133.32) 15(26.32%) 15(26.32%) 6(5.83%) 265.65(111.43) 2(1.94%) 311.55(109.41) 19(18.45%) 10(9.71%) 0.443 0.000* 0.045* 0.451 0.244 0.006* Data are given as n/N (%); GBS: group B streptococcus; CS: cesarean section; NICU: neonatal intensive care unit. * p < 0.05 was considered statistically significant. For the purpose of analysis, both subscales and total scores were utilized. The scores for each subscale vary between 1 and 4, with higher values representing a better birth experience (1 = disagree completely, 2 = disagree mostly, 3 = agree mostly, 4 = agree completely). The mean total CEQ score for women in LDRP was 3.48 (SD 0.25). In “Own capacity it was 3.38 (SD 0.40), in “Professional support” it was 3.91 (SD 0.19), in “Perceived safety” it was 3.16 (SD 0.51), and in “Participation” it was 3.22 (SD 0.56). When comparing women in ordinary room, differences were detectable (p < 0.01) (Table 5 ). Table 5 Score of the individual items of the CEQ-C in both groups LDRP Mean Median SD IQR Ordinary Mean Median SD IQR P-value Professional support Own capacity Perceived safety Participation Total CEQ score 3.91 4.00 0.19 0.17 3.38 3.42 0.40 0.50 3.16 3.25 0.51 0.75 3.22 3.33 0.56 0.67 3.48 3.47 0.25 0.36 2.99 3.00 0.51 0.46 2.65 2.50 0.50 0.79 2.34 2.25 0.47 0.50 2.73 2.67 0.58 1.00 2.70 2.63 0.38 0.41 0.000* 0.000* 0.000* 0.000* 0.000* * p < 0.05 was considered statistically significant. DISCUSSION Pregnancy and childbirth are complex and unique, the delivery environment, delivery process, stress response and maternal emotional state will all affect the outcome of delivery. Previous studies have demonstrated that anxiety and stress during labor can lead to increased need for sedation[ 16 ], reduced progression of uterine contractions and longer labor[ 17 ], and lower neonatal APGAR scores[ 18 ]. In our study, results showed that with the same induction method and similar cervical Bishop score, women who gave birth in LDRP had a shorter time from induction to delivery compared to those who gave birth in a traditional labor and delivery room. Prolonged labor was mainly concentrated in the first stage of labor, and there was little difference in the second stage of labor. A relaxing environment, the company of family members, and one-on-one labor management by senior midwives are all factors that may accelerate cervical dilation and contribute to a smoother childbirth experience for the mother. More importantly, these interventions may increase a woman's faith in her own ability to cope with labor and birth. The occurrence of maternal intrapartum fever is a regular phenomenon among women in labor receiving epidural analgesia[ 19 ]. we also observed this phenomenon in our research. All participants received epidural analgesia during labor, and almost 36% (57 in 160) of the pregnant women developed fever. In addition, GBS, a common bacteria found in the vaginal and rectal areas (should be screened for during pregnancy) has also been linked to intrapartum fever[ 20 ]. However, in our study, group B Streptococcus carriage did not increase intrapartum fever in the participants. Generally speaking, intrapartum fever exceeding 38℃ can signal an underlying infection and increase the risk of adverse maternal and fetal complications[ 21 ]. We also found higher occurrences of instrumental delivery and NICU admission in fever group. In this study, it was showed that in the LDRP group, only 6.25% of the mothers had a fever exceeding 38℃, which was much lower than that in the ordinary delivery room delivery group. According to a recent study[ 22 ], prolonged duration of the first stage of labor has been found to be significantly associated with an increased risk of maternal fever. Our study revealed that the first stage of labor was notably shorter for the LDRP group than the ordinary delivery room group. This may be related to reduced intrapartum fever in LDRP. Negative delivery experiences may be linked to delivery methods that involve induced labor and surgery, such as cesarean section, vacuum delivery, and forceps[ 9 , 23 ]. All participants were given a birth experience questionnaire to assess their satisfaction with the delivery process. According to a prior investigation, the timing of CEQ administration revealed that completing the questionnaire within the initial week postpartum and again after 3 months led to a decrease in scores for the categories of "Professional support" and "Participation”. Therefore, our questionnaire was distributed 3 days after delivery before the patient was discharged from the hospital to allow for ample time for recovery and reflection on their experience. The Chinese version of the Childbirth Experience Questionnaire (CEQ-C) was revised and formed[ 4 ], and a survey of 1,747 domestic women with vaginal delivery showed that among the four dimensions of personal ability, professional support, sense of security, and participation, maternal safety and participation scored the lowest. This highlights the need for improved safety protocols and increased involvement of women in their own childbirth experiences. According to the CEQ-C scores in LDRP group, the childbirth experience of first-time mothers undergoing cervical ripening and labor induction was largely positive, with an average score of 3.48. Notable differences in CEQ-C scores were detectable when comparing LDRP and ordinary room, and the women in LDRP were more content with their labor induction. The LDRP unit is known for its exceptional level of professional support, as senior doctors oversee all labor management, ensuring top-quality care for patients during labor and delivery. The study's potential drawbacks may include selection bias in the selection of research subjects, as women were not randomly assigned to LDRP or traditional delivery room care. Moreover, the study may not accurately represent all women who underwent double-balloon catheter induction due to participation limitations. CONCLUSION The LDRP delivery model, which combines labor, delivery, recovery, and postpartum care in one room, can significantly improve the overall delivery experience for mothers and contribute to better physical and mental health outcomes for both the mother and child. In order to improve the quality of care in LDRP, it is necessary to invest more manpower and material resources. This may result in an increase in cost, but the health and well-being of their patients should be the top priority. On the other hand, there are certain restrictions that come with its use, including limited availability in rural locations and higher expenses for patients. Declarations Ethics approval and consent to participate This study was reviewed and approved by the ethics committee of Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University (ethical approval number: 2020 medical ethics (express)-37) with informed consent obtained from all participating pregnant women and their families. Consent for publication Not applicable. Acknowledgements We would like to express our thanks to all the midwives who contributed to this study. We are also indebted to them for their input in broadening the questionnaire. Availability of data and materials The authors were granted complete access to the data and materials. Interested parties may request access to the data from the authors. Competing interests The authors have explicitly declared that there are no conflicts of interest in relation to this article. Funding The Technology Bureau of Jiaxing, Zhejiang province (2021AD30055), and the Health Development Planning Commission of the Zhejiang province (2021KY357) provided funding for this work. Authors’ contributions Jinhua Dong and Qiang Ma designed and organized the study. Chunfeng Gao wrote the original manuscript draft. Fang Chen and Qingqing Ni analyzed the data and prepared table 1-5. The manuscript was revised by all authors and a final version was agreed upon. References Molgora S, Fenaroli V, Saita E. The association between childbirth experience and mother's parenting stress: The mediating role of anxiety and depressive symptoms. Women Health. 2020;60(3):341–51. Dal Moro APM, et al. Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil. BMC Pregnancy Childbirth. 2023;23(1):632. Maimburg RD, Væth M, Dahlen H. 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Maternal childbirth experience in induced and spontaneous labour measured in a visual analog scale and the factors influencing it; a two-year cohort study. BMC Pregnancy Childbirth. 2020;20(1):415. Liu YR, et al. Double-balloon catheter versus dinoprostone insert for labour induction: a meta-analysis. Arch Gynecol Obstet. 2019;299(1):7–12. Alkmark M, et al. Efficacy and safety of oral misoprostol vs transvaginal balloon catheter for labor induction: An observational study within the SWEdish Postterm Induction Study (SWEPIS). Acta Obstet Gynecol Scand. 2021;100(8):1463–77. Weeks AD, et al. Evaluating misoprostol and mechanical methods for induction of labour: Scientific Impact Paper 68 April 2022. BJOG. 2022;129(8):e61–5. Liu X, et al. Double- versus single-balloon catheters for labour induction and cervical ripening: a meta-analysis. BMC Pregnancy Childbirth. 2019;19(1):358. Place K, Kruit H, Rahkonen L. 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Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors. Int J Nurs Pract. 2024;30(1):e13188. Mei JY, Silverman NS. Group B Streptococcus in Pregnancy. Obstet Gynecol Clin North Am. 2023;50(2):375–87. Abu Shqara R et al. Antibiotic treatment of women with isolated intrapartum fever vs clinical chorioamnionitis: maternal and neonatal outcomes. Am J Obstet Gynecol, 2023. 229(5): p. 540.e1-540.e9. Blankenship SA et al. Association of abnormal first stage of labor duration and maternal and neonatal morbidity. Am J Obstet Gynecol, 2020. 223(3): p. 445.e1-445.e15. Falk M, Nelson M, Blomberg M. The impact of obstetric interventions and complications on women's satisfaction with childbirth a population based cohort study including 16,000 women. BMC Pregnancy Childbirth. 2019;19(1):494. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4166038","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284791543,"identity":"423b4c6a-c0c8-4657-a5af-73b4a6081bf6","order_by":0,"name":"Chunfeng Gao","email":"","orcid":"","institution":"Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chunfeng","middleName":"","lastName":"Gao","suffix":""},{"id":284791544,"identity":"a90fe3c4-532f-4188-8fbf-f1e6bb8a4b38","order_by":1,"name":"Qiang Ma","email":"","orcid":"","institution":"Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Ma","suffix":""},{"id":284791545,"identity":"621ace53-f903-4c19-be18-b19d19a43e78","order_by":2,"name":"Jinhua Dong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBACxmYGNiDFDMIHGCTAYglEa2FLIE4LSClUC48BVICAFuZ23mOPeWqs5cz513z+YNl2mIGfPceA4ecOfA7jSzfmOZZubDnj7QYDiTOHGSR73hgw9p7Bp4XHTJqH7XDihhtnNyRIVBxmMLiRY8DM2EZIyz+QljMPDkgYHGawJ0oLbxtQy/kexgawLRJEaJGc25dubHCDzZhB4kw6j8SZZwUHe/FoMew/Yybx5pu1nMH5w48/S7ZZy/G3J2988BOflgYYSyKBgRkYlTwg9gHcGhgY5OEs/gMMjB/wKR0Fo2AUjIIRCwAbwEzA7fCqXgAAAABJRU5ErkJggg==","orcid":"","institution":"Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jinhua","middleName":"","lastName":"Dong","suffix":""},{"id":284791546,"identity":"bbba700f-06b8-4efe-93b1-43094863a60a","order_by":3,"name":"Fang Chen","email":"","orcid":"","institution":"Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Chen","suffix":""},{"id":284791547,"identity":"97bb82b2-3206-4f31-9e6d-e6047351125c","order_by":4,"name":"Qingqing Ni","email":"","orcid":"","institution":"Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qingqing","middleName":"","lastName":"Ni","suffix":""}],"badges":[],"createdAt":"2024-03-26 00:44:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4166038/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4166038/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94592769,"identity":"934fc015-e88d-4a04-a1e1-392dedd57db4","added_by":"auto","created_at":"2025-10-28 18:23:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":533824,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4166038/v1/39d5d998-d71c-452a-8b6d-9d44e11a23bc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cervical Balloon Induction in LDRP Unit: Effects on Maternal and Neonatal Outcomes for Primiparous Women","fulltext":[{"header":"Background","content":"\u003cp\u003eIn many cultures, childbirth is seen as a significant stress event for mothers, which can greatly influence their physical and mental well-being. Research has shown that the experience of childbirth can have varying impacts on the mother's physiology, psychology, and even the dynamics of the entire family[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A negative childbirth experience can greatly affect a mother's self-esteem, self-efficacy, and overall quality of life postpartum. This can ultimately lead to a higher incidence of postpartum depression[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Many believe that the childbirth experience is just as important as the outcome of the delivery itself, as it can greatly impact a woman's bodily and psychological health. According to a study[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] conducted by Zhu et al. (2020), the childbirth experience scores of Chinese mothers were found to be generally lower than those of other Western countries, such as Sweden, the United Kingdom, and Spain, based on delivery time. There is a recommendation for the enhancement of the delivery experience among Chinese mothers. In fact, it is now being recognized as a crucial indicator for measuring the quality of obstetric care[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the development of China's medical and health services, including better access to prenatal care and advancements in technology, the maternal mortality rate has significantly decreased. As a result, improving the delivery experience of pregnant women has become a top priority in maternal and child health care[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. To ensure positive childbirth experiences, it is necessary to provide women with respectful and evidence-based intrapartum care. Consequently, many medical facilities have implemented a unit in their hospitals and birthing centers known as LDRP (an abbreviation for labor, delivery, recovery, and postpartum) covering all stages from labor preparation to postpartum recovery, with the purpose of providing family-oriented care. Research[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] has shown that women and their families have a more enjoyable and less stressful birth experience when they have the opportunity to give birth in a room designed to feel like a home. Conversely, a qualitative study suggested that a deficiency of family support during childbirth had a negative effect on women's mental health during childbirth[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The LDRP unit boasts a calm and inviting environment, allowing mothers and their families to fully immerse themselves in the birth experience. Moreover, the facility offers some specialized care for any potential complications that may occur during labor, ensuring the safety and well-being of both the mother and her baby.\u003c/p\u003e \u003cp\u003eDue to certain medical conditions, such as gestational diabetes or preeclampsia, some pregnant women in the third trimester may need to undergo labor induction. According to recent studies[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the induction of labor, especially when cervical ripening is necessary, has been identified as a known risk factor for a negative birth experience. This risk is heightened for nulliparous women, compared to women who have had multiple pregnancies. There are two common methods for initiating cervical ripening - mechanical with a balloon catheter and pharmacological with prostaglandins. Both have been extensively studied and have shown to be safe and effective[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, recent research has suggested that the double-balloon catheter may be a safer approach for patients[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe LDRP delivery model, which is gaining popularity in China for its emphasis on natural delivery, may not be suitable for pregnant women who are at a higher risk for complications. Because the LDRP unit is located further away from the operating room compared to the ordinary delivery room, potentially causing delays in emergency surgeries. Furthermore, due to the added family members, the sterile environment will be compromised and the likelihood of infections will rise. There is limited data on the safety and effectiveness of induced labor in LDRP births, prompting further research and investigation.\u003c/p\u003e \u003cp\u003eThe purpose of this study was to compare the delivery outcomes and childbirth experiences of primiparous women using double-balloon catheters to induce labor in LDRP and ordinary delivery rooms in order to determine the more effective and comfortable method for mothers and babies.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eThis prospective study was carried out between January 1, 2022, and October 1, 2022 at the Department of Obstetrics, Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University. We included primiparous women with viable singleton term pregnancies undergoing cervical ripening and labor induction by double-balloon catheter. This study was reviewed and approved by the ethics committee of the hospital (ethical approval number: 2020 medical ethics (express)-37) with informed consent obtained from all participating pregnant women and their families.\u003c/p\u003e \u003cp\u003eAccording to the wishes of the pregnant women, the study divided participants into two groups: those admitted to the LDRP unit and those who gave birth in the ordinary delivery room. Participants in the study were nulliparous and in the late stages of pregnancy, between 37 and 41 weeks, with a Bishop score of \u0026lt; 6. Exclusion criteria were carefully considered in order to ensure a homogeneous sample. These criteria included multiple gestation, premature rupture of membranes, placental abruption, fetal distress, previous uterine surgery, chorioamnionitis or active infection of the birth canal, and fetal malformations.\u003c/p\u003e \u003cp\u003eDuring the surgical procedure, the Cook Cervical Ripening Balloon (CCRB) was inserted into the cervical canal using oval forceps. Following this, both the intrauterine and intravaginal balloons were filled with 80 mL of saline solution and left in place for about 12 hours to promote cervical dilation. The next step was that when the cervix reached a Bishop score of \u0026ge;\u0026thinsp;6, the doctor performed an amniotomy to speed up the labor process. After an hour of waiting, since the mother was not experiencing regular uterine contractions, oxytocin was also administered intravenously to help stimulate them. When the cervix dilated to 2 cm, all pregnant women underwent analgesic delivery to help manage their pain during labor.\u003c/p\u003e \u003cp\u003eThe following variables were recorded during the study: maternal age, gestational age, gravidity, body mass index, Bishop score, indications for induced labor, hours of labor induction, amount of postpartum bleeding, neonatal 1-5minute score, intrapartum fever (\u0026gt;\u0026thinsp;38\u0026deg;C), cesarean section, and instrumental delivery situation. Information on the characteristics and delivery outcomes of the study population was retrieved from patient records. After 3 days postpartum before discharge, the multidimensional Chinese version of Childbirth Experience Questionnaire (CEQ-C) was used as the childbirth experience survey method. Four categories within the questionnaire measured aspects of the birth experience: personal proficiency, perceived safety, professional guidance, and involvement.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 26.0 statistical software. Student's t-test was utilized to compare the variations between groups, when appropriate, with findings presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. The categorical information was presented as either counts or percentages and was assessed through χ2 (Fisher's exact) analysis. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to show statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e160 nulliparous women were recruited for the research. Each group consisted of 80 women, with the LDRP group being the observation group and the ordinary delivery room group being the control group. The two groups had similar clinical baseline parameters, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, with no significant differences noted.\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\u003eClinical and demographic characteristics of the study population\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\u003e\u003cem\u003eLDRP\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;80)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eOrdinary\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;80)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (year)\u003c/p\u003e \u003cp\u003eGestational age (week)\u003c/p\u003e \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003cp\u003eBishop score\u003c/p\u003e \u003cp\u003eGBS+\u003c/p\u003e \u003cp\u003eIndications for labor induction\u003c/p\u003e \u003cp\u003eGestational diabetes\u003c/p\u003e \u003cp\u003eIntrahepatic cholestasis of pregnancy\u003c/p\u003e \u003cp\u003ePreeclampsia or Gestational hypertension\u003c/p\u003e \u003cp\u003eImmune system diseases\u003c/p\u003e \u003cp\u003eFetal growth restriction\u003c/p\u003e \u003cp\u003eSuspected macrosomia\u003c/p\u003e \u003cp\u003eDelayed pregnancy\u003c/p\u003e \u003cp\u003eOther reasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e28.05(4.38)\u003c/p\u003e \u003cp\u003e39.54(0.95)\u003c/p\u003e \u003cp\u003e26.86(3.23)\u003c/p\u003e \u003cp\u003e4.91(0.28)\u003c/p\u003e \u003cp\u003e8(10%)\u003c/p\u003e \u003cp\u003e14(18.5%)\u003c/p\u003e \u003cp\u003e2(2.5%)\u003c/p\u003e \u003cp\u003e7(8.75%)\u003c/p\u003e \u003cp\u003e2(2.5%)\u003c/p\u003e \u003cp\u003e7(8.75%)\u003c/p\u003e \u003cp\u003e21(26.25%)\u003c/p\u003e \u003cp\u003e5(6.25%)\u003c/p\u003e \u003cp\u003e22(27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e27.83(3.24) 39.58(0.95)\u003c/p\u003e \u003cp\u003e27.77(3.28)\u003c/p\u003e \u003cp\u003e4.94(0.24)\u003c/p\u003e \u003cp\u003e4(5%)\u003c/p\u003e \u003cp\u003e12(15%)\u003c/p\u003e \u003cp\u003e2(2.5%)\u003c/p\u003e \u003cp\u003e11(13.75%)\u003c/p\u003e \u003cp\u003e7(8.75%)\u003c/p\u003e \u003cp\u003e3(3.75%)\u003c/p\u003e \u003cp\u003e12(15%)\u003c/p\u003e \u003cp\u003e6(7.5%)\u003c/p\u003e \u003cp\u003e27(33.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003cp\u003e0.926\u003c/p\u003e \u003cp\u003e0.077\u003c/p\u003e \u003cp\u003e0.550\u003c/p\u003e \u003cp\u003e0.230\u003c/p\u003e \u003cp\u003e0.668\u003c/p\u003e \u003cp\u003e1.000\u003c/p\u003e \u003cp\u003e0.317\u003c/p\u003e \u003cp\u003e0.170\u003c/p\u003e \u003cp\u003e0.191\u003c/p\u003e \u003cp\u003e0.079\u003c/p\u003e \u003cp\u003e0.755\u003c/p\u003e \u003cp\u003e0.391\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\u003eData are given as mean (standard deviation) or n (%). GBS: group B streptococcus; other reasons: subclinical hypothyroidism, mild arrhythmia, pregnant women's requirements, borderline oligohydramnios.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe durations of the first stage of labor and total labor in the study group were significantly shorter than those of the control group (for the first stage (262.87\u0026thinsp;\u0026plusmn;\u0026thinsp;98.60) min vs. (360.34\u0026thinsp;\u0026plusmn;\u0026thinsp;151.30) min, p\u0026thinsp;=\u0026thinsp;0.000; for the total labor (333.16\u0026thinsp;\u0026plusmn;\u0026thinsp;107.11) min vs. (434.88\u0026thinsp;\u0026plusmn;\u0026thinsp;154.49) min, p\u0026thinsp;=\u0026thinsp;0.000). There were no significant differences in the length of the second labor. It was found that the incidence of intrapartum fever in the LDRP group was significantly lower than that in the ordinary delivery room group (p\u0026lt;0.05). There was no difference between the two groups in conversion to cesarean section (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003epresents delivery and neonatal outcomes\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\u003e\u003cem\u003eLDRP\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;80)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eOrdinary\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;80)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal stage of labor (min)\u003c/p\u003e \u003cp\u003eFirst stage of labor (min)\u003c/p\u003e \u003cp\u003eSecond stage of labor (min)\u003c/p\u003e \u003cp\u003eAmount of postpartum bleeding (ml)\u003c/p\u003e \u003cp\u003ePostpartum hemorrhage\u003c/p\u003e \u003cp\u003ePostpartum infection\u003c/p\u003e \u003cp\u003e38\u0026deg;C\u0026lt;Intrapartum fever\u0026thinsp;\u0026ge;\u0026thinsp;37.5\u0026deg;C\u003c/p\u003e \u003cp\u003eIntrapartum fever\u0026thinsp;\u0026ge;\u0026thinsp;38.0\u0026deg;C\u003c/p\u003e \u003cp\u003eType of delivery\u003c/p\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003cp\u003eInstrumental\u003c/p\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003cp\u003eBirth weight (g)\u003c/p\u003e \u003cp\u003eApgar score at 1 min\u003c/p\u003e \u003cp\u003eApgar score at 5 min\u003c/p\u003e \u003cp\u003eAdmissions to NICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e333.16(107.11)\u003c/p\u003e \u003cp\u003e262.87(98.60)\u003c/p\u003e \u003cp\u003e65.16(33.48)\u003c/p\u003e \u003cp\u003e330.00(148.42)\u003c/p\u003e \u003cp\u003e5(6.25%)\u003c/p\u003e \u003cp\u003e10(12.5%)\u003c/p\u003e \u003cp\u003e11(13.75%)\u003c/p\u003e \u003cp\u003e5(6.25%)\u003c/p\u003e \u003cp\u003e58(72.5%)\u003c/p\u003e \u003cp\u003e10(12.5%)\u003c/p\u003e \u003cp\u003e12(15%)\u003c/p\u003e \u003cp\u003e3372.38(361.54)\u003c/p\u003e \u003cp\u003e9.84(0.46)\u003c/p\u003e \u003cp\u003e9.89(0.32)\u003c/p\u003e \u003cp\u003e2(2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e434.88(154.49)\u003c/p\u003e \u003cp\u003e360.34(151.30)\u003c/p\u003e \u003cp\u003e61.50(34.85)\u003c/p\u003e \u003cp\u003e303.63(76.00)\u003c/p\u003e \u003cp\u003e3(3.75%)\u003c/p\u003e \u003cp\u003e16(20%)\u003c/p\u003e \u003cp\u003e23(28.75%)\u003c/p\u003e \u003cp\u003e18(22.5%)\u003c/p\u003e \u003cp\u003e43(53.75%)\u003c/p\u003e \u003cp\u003e15(18.75%)\u003c/p\u003e \u003cp\u003e22(27.5%)\u003c/p\u003e \u003cp\u003e3362.88(415.65)\u003c/p\u003e \u003cp\u003e9.65(0.62)\u003c/p\u003e \u003cp\u003e9.84(0.37)\u003c/p\u003e \u003cp\u003e6(7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.518\u003c/p\u003e \u003cp\u003e0.886\u003c/p\u003e \u003cp\u003e0.717\u003c/p\u003e \u003cp\u003e0.199\u003c/p\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.014*\u003c/p\u003e \u003cp\u003e0.276\u003c/p\u003e \u003cp\u003e0.053\u003c/p\u003e \u003cp\u003e0.878\u003c/p\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003cp\u003e0.360\u003c/p\u003e \u003cp\u003e0.277\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\u003eData are given as mean (standard deviation) or n (%). NICU: neonatal intensive care unit. * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOperative delivery indications did not vary between the two groups as it was showed in Table \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\u003eOperative delivery in both study groups according to indication\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\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eLDRP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eOrdinary\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\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\u003eInstrumental delivery for risk of fetal distress\u003c/p\u003e \u003cp\u003eInstrumental delivery for prolonged expulsive (\u0026gt;\u0026thinsp;2 h)\u003c/p\u003e \u003cp\u003eCS for risk of fetal distress\u003c/p\u003e \u003cp\u003eCS for failed induction\u003c/p\u003e \u003cp\u003eCS for stagnant labor\u003c/p\u003e \u003cp\u003eCS for cephalopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/10 (60%)\u003c/p\u003e \u003cp\u003e4 /10(40%)\u003c/p\u003e \u003cp\u003e2/12 (17%)\u003c/p\u003e \u003cp\u003e1/12 (8%)\u003c/p\u003e \u003cp\u003e5/12(42%)\u003c/p\u003e \u003cp\u003e4/12(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11/15(73%)\u003c/p\u003e \u003cp\u003e4/15(27%)\u003c/p\u003e \u003cp\u003e5/22(23%)\u003c/p\u003e \u003cp\u003e5/22 (23%)\u003c/p\u003e \u003cp\u003e6/22(27%)\u003c/p\u003e \u003cp\u003e6/22(27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003cp\u003e0.667\u003c/p\u003e \u003cp\u003e1.000\u003c/p\u003e \u003cp\u003e0.389\u003c/p\u003e \u003cp\u003e0.459\u003c/p\u003e \u003cp\u003e0.714\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\u003eData are given as n/N (%); Instrumental delivery: forceps or vacuum\u003c/em\u003e extraction; \u003cem\u003eCS: cesarean section.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThere was no significant difference in the carriage rate of group B streptococcus (GBS) between the fever group and the normal temperature group. The fever group experienced a notably extended period of time during the first stage of labor. The normal temperature group showed lower occurrences of instrumental delivery and neonatal intensive care unit (NICU) admission (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\u003eOutcomes of intrapartum fever\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\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFever(n\u0026thinsp;=\u0026thinsp;57)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003enormal (n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\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\u003eGBS+\u003c/p\u003e \u003cp\u003eFirst stage of labor (min)\u003c/p\u003e \u003cp\u003eAdmissions to NICU\u003c/p\u003e \u003cp\u003ePostpartum hemorrhage (ml)\u003c/p\u003e \u003cp\u003eCS delivery\u003c/p\u003e \u003cp\u003eInstrumental delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(10.53%)\u003c/p\u003e \u003cp\u003e391.90(137.65)\u003c/p\u003e \u003cp\u003e6(10.53%)\u003c/p\u003e \u003cp\u003e326.32(133.32)\u003c/p\u003e \u003cp\u003e15(26.32%)\u003c/p\u003e \u003cp\u003e15(26.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6(5.83%)\u003c/p\u003e \u003cp\u003e265.65(111.43)\u003c/p\u003e \u003cp\u003e2(1.94%)\u003c/p\u003e \u003cp\u003e311.55(109.41)\u003c/p\u003e \u003cp\u003e19(18.45%)\u003c/p\u003e \u003cp\u003e10(9.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.045*\u003c/p\u003e \u003cp\u003e0.451\u003c/p\u003e \u003cp\u003e0.244\u003c/p\u003e \u003cp\u003e0.006*\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\u003eData are given as n/N (%); GBS: group B streptococcus; CS: cesarean section; NICU: neonatal intensive care unit. * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFor the purpose of analysis, both subscales and total scores were utilized. The scores for each subscale vary between 1 and 4, with higher values representing a better birth experience (1\u0026thinsp;=\u0026thinsp;disagree completely, 2\u0026thinsp;=\u0026thinsp;disagree mostly, 3\u0026thinsp;=\u0026thinsp;agree mostly, 4\u0026thinsp;=\u0026thinsp;agree completely). The mean total CEQ score for women in LDRP was 3.48 (SD 0.25). In \u0026ldquo;Own capacity it was 3.38 (SD 0.40), in \u0026ldquo;Professional support\u0026rdquo; it was 3.91 (SD 0.19), in \u0026ldquo;Perceived safety\u0026rdquo; it was 3.16 (SD 0.51), and in \u0026ldquo;Participation\u0026rdquo; it was 3.22 (SD 0.56). When comparing women in ordinary room, differences were detectable (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScore of the individual items of the CEQ-C in both 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\u003e\u003cem\u003eLDRP\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean Median SD IQR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrdinary\u003c/p\u003e \u003cp\u003eMean Median SD IQR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional support\u003c/p\u003e \u003cp\u003eOwn capacity\u003c/p\u003e \u003cp\u003ePerceived safety\u003c/p\u003e \u003cp\u003eParticipation\u003c/p\u003e \u003cp\u003eTotal CEQ score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.91 4.00 0.19 0.17\u003c/p\u003e \u003cp\u003e3.38 3.42 0.40 0.50\u003c/p\u003e \u003cp\u003e3.16 3.25 0.51 0.75\u003c/p\u003e \u003cp\u003e3.22 3.33 0.56 0.67\u003c/p\u003e \u003cp\u003e3.48 3.47 0.25 0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.99 3.00 0.51 0.46\u003c/p\u003e \u003cp\u003e2.65 2.50 0.50 0.79\u003c/p\u003e \u003cp\u003e2.34 2.25 0.47 0.50\u003c/p\u003e \u003cp\u003e2.73 2.67 0.58 1.00\u003c/p\u003e \u003cp\u003e2.70 2.63 0.38 0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003cp\u003e0.000*\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* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePregnancy and childbirth are complex and unique, the delivery environment, delivery process, stress response and maternal emotional state will all affect the outcome of delivery. Previous studies have demonstrated that anxiety and stress during labor can lead to increased need for sedation[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], reduced progression of uterine contractions and longer labor[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and lower neonatal APGAR scores[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our study, results showed that with the same induction method and similar cervical Bishop score, women who gave birth in LDRP had a shorter time from induction to delivery compared to those who gave birth in a traditional labor and delivery room. Prolonged labor was mainly concentrated in the first stage of labor, and there was little difference in the second stage of labor. A relaxing environment, the company of family members, and one-on-one labor management by senior midwives are all factors that may accelerate cervical dilation and contribute to a smoother childbirth experience for the mother. More importantly, these interventions may increase a woman's faith in her own ability to cope with labor and birth.\u003c/p\u003e \u003cp\u003eThe occurrence of maternal intrapartum fever is a regular phenomenon among women in labor receiving epidural analgesia[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. we also observed this phenomenon in our research. All participants received epidural analgesia during labor, and almost 36% (57 in 160) of the pregnant women developed fever. In addition, GBS, a common bacteria found in the vaginal and rectal areas (should be screened for during pregnancy) has also been linked to intrapartum fever[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, in our study, group B Streptococcus carriage did not increase intrapartum fever in the participants. Generally speaking, intrapartum fever exceeding 38℃ can signal an underlying infection and increase the risk of adverse maternal and fetal complications[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. We also found higher occurrences of instrumental delivery and NICU admission in fever group. In this study, it was showed that in the LDRP group, only 6.25% of the mothers had a fever exceeding 38℃, which was much lower than that in the ordinary delivery room delivery group. According to a recent study[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], prolonged duration of the first stage of labor has been found to be significantly associated with an increased risk of maternal fever. Our study revealed that the first stage of labor was notably shorter for the LDRP group than the ordinary delivery room group. This may be related to reduced intrapartum fever in LDRP.\u003c/p\u003e \u003cp\u003eNegative delivery experiences may be linked to delivery methods that involve induced labor and surgery, such as cesarean section, vacuum delivery, and forceps[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. All participants were given a birth experience questionnaire to assess their satisfaction with the delivery process. According to a prior investigation, the timing of CEQ administration revealed that completing the questionnaire within the initial week postpartum and again after 3 months led to a decrease in scores for the categories of \"Professional support\" and \"Participation\u0026rdquo;. Therefore, our questionnaire was distributed 3 days after delivery before the patient was discharged from the hospital to allow for ample time for recovery and reflection on their experience.\u003c/p\u003e \u003cp\u003eThe Chinese version of the Childbirth Experience Questionnaire (CEQ-C) was revised and formed[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and a survey of 1,747 domestic women with vaginal delivery showed that among the four dimensions of personal ability, professional support, sense of security, and participation, maternal safety and participation scored the lowest. This highlights the need for improved safety protocols and increased involvement of women in their own childbirth experiences. According to the CEQ-C scores in LDRP group, the childbirth experience of first-time mothers undergoing cervical ripening and labor induction was largely positive, with an average score of 3.48. Notable differences in CEQ-C scores were detectable when comparing LDRP and ordinary room, and the women in LDRP were more content with their labor induction. The LDRP unit is known for its exceptional level of professional support, as senior doctors oversee all labor management, ensuring top-quality care for patients during labor and delivery.\u003c/p\u003e \u003cp\u003eThe study's potential drawbacks may include selection bias in the selection of research subjects, as women were not randomly assigned to LDRP or traditional delivery room care. Moreover, the study may not accurately represent all women who underwent double-balloon catheter induction due to participation limitations.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe LDRP delivery model, which combines labor, delivery, recovery, and postpartum care in one room, can significantly improve the overall delivery experience for mothers and contribute to better physical and mental health outcomes for both the mother and child. In order to improve the quality of care in LDRP, it is necessary to invest more manpower and material resources. This may result in an increase in cost, but the health and well-being of their patients should be the top priority. On the other hand, there are certain restrictions that come with its use, including limited availability in rural locations and higher expenses for patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the ethics committee of Jiaxing Women and Children\u0026apos;s Hospital affiliated to Wenzhou Medical University (ethical approval number: 2020 medical ethics (express)-37) with informed consent obtained from all participating pregnant women and their families.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our thanks to all the midwives who contributed to this study. We are also indebted to them for their input in broadening the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors were granted complete access to the data and materials. Interested parties may request access to the data from the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have explicitly declared that there are no conflicts of interest in relation to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Technology Bureau of Jiaxing, Zhejiang province (2021AD30055), and the Health Development Planning Commission of the Zhejiang province (2021KY357) provided funding for this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJinhua Dong and Qiang Ma designed and organized the study. Chunfeng Gao wrote the original manuscript draft. Fang Chen and Qingqing Ni analyzed the data and prepared table 1-5. The manuscript was revised by all authors and a final version was agreed upon.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMolgora S, Fenaroli V, Saita E. The association between childbirth experience and mother's parenting stress: The mediating role of anxiety and depressive symptoms. Women Health. 2020;60(3):341\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDal Moro APM, et al. Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil. BMC Pregnancy Childbirth. 2023;23(1):632.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaimburg RD, V\u0026aelig;th M, Dahlen H. Women's experience of childbirth - A five year follow-up of the randomised controlled trial Ready for Child Trial. Women Birth. 2016;29(5):450\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu X, et al. Adaptation of the Childbirth Experience Questionnaire (CEQ) in China: A multisite cross-sectional study. PLoS ONE. 2019;14(4):e0215373.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJafari E, Mohebbi P, Mazloomzadeh S. Factors Related to Women's Childbirth Satisfaction in Physiologic and Routine Childbirth Groups. Iran J Nurs Midwifery Res. 2017;22(3):219\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiao J et al. \u003cem\u003eA Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China.\u003c/em\u003e 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsfeh BK, Kazemi A, Shamsaie A. Designing architecture of soothing labor-delivery-recovery-postpartum unit: a study protocol. Reprod Health. 2020;17(1):196.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang D, et al. Exploring Contributing Factors to Psychological Traumatic Childbirth from the Perspective of Midwives: A Qualitative Study. Asian Nurs Res (Korean Soc Nurs Sci). 2019;13(4):270\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdler K, Rahkonen L, Kruit H. Maternal childbirth experience in induced and spontaneous labour measured in a visual analog scale and the factors influencing it; a two-year cohort study. BMC Pregnancy Childbirth. 2020;20(1):415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu YR, et al. Double-balloon catheter versus dinoprostone insert for labour induction: a meta-analysis. Arch Gynecol Obstet. 2019;299(1):7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkmark M, et al. Efficacy and safety of oral misoprostol vs transvaginal balloon catheter for labor induction: An observational study within the SWEdish Postterm Induction Study (SWEPIS). Acta Obstet Gynecol Scand. 2021;100(8):1463\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeeks AD, et al. Evaluating misoprostol and mechanical methods for induction of labour: Scientific Impact Paper 68 April 2022. BJOG. 2022;129(8):e61\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu X, et al. Double- versus single-balloon catheters for labour induction and cervical ripening: a meta-analysis. BMC Pregnancy Childbirth. 2019;19(1):358.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlace K, Kruit H, Rahkonen L. Comparison of primiparous women's childbirth experience in labor induction with cervical ripening by balloon catheter or oral misoprostol - a prospective study using a validated childbirth experience questionnaire (CEQ) and visual analogue scale (VAS). Acta Obstet Gynecol Scand. 2022;101(10):1153\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWen C, et al. Conventional versus modified application of COOK Cervical Ripening Balloon for induction of labor at term: a randomized controlled trial. BMC Pregnancy Childbirth. 2022;22(1):739.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoyer J, et al. Do lifetime anxiety disorders (anxiety liability) and pregnancy-related anxiety predict complications during pregnancy and delivery? Early Hum Dev. 2020;144:105022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTzeng YL, et al. Pain, Anxiety, and Fatigue During Labor: A Prospective, Repeated Measures Study. J Nurs Res. 2017;25(1):59\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmorti M, Ponti L, Tani F. The effect of maternal depression and anxiety on labour and the well-being of the newborn. J Obstet Gynaecol. 2019;39(4):492\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan J, et al. Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors. Int J Nurs Pract. 2024;30(1):e13188.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMei JY, Silverman NS. Group B Streptococcus in Pregnancy. Obstet Gynecol Clin North Am. 2023;50(2):375\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu Shqara R et al. \u003cem\u003eAntibiotic treatment of women with isolated intrapartum fever vs clinical chorioamnionitis: maternal and neonatal outcomes.\u003c/em\u003e Am J Obstet Gynecol, 2023. 229(5): p. 540.e1-540.e9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlankenship SA et al. \u003cem\u003eAssociation of abnormal first stage of labor duration and maternal and neonatal morbidity.\u003c/em\u003e Am J Obstet Gynecol, 2020. 223(3): p. 445.e1-445.e15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalk M, Nelson M, Blomberg M. The impact of obstetric interventions and complications on women's satisfaction with childbirth a population based cohort study including 16,000 women. BMC Pregnancy Childbirth. 2019;19(1):494.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"LDRP, cervical balloon, induction, experience of childbirth","lastPublishedDoi":"10.21203/rs.3.rs-4166038/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4166038/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: To compare the delivery outcomes and childbirth experiences of primiparous women using double-balloon catheters to induce labor in LDRP (labor waiting, delivery and postpartum recovery) unit and in ordinary delivery room.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 160 cases of primiparous women undergoing induced labor with double-balloon catheters in Jiaxing Women and Children's Hospital affiliated to Wenzhou Medical University between January 2022 and October 2022 were selected as the study group, either in LDRP unit or in ordinary delivery room. Age, gestational week, BMI, induced labor outcome, and blood loss at 2 hours postpartum were evaluated and compared between the two groups. Three days after delivery, the women assessed their childbirth experience using the Chinese version of Childbirth Experience Questionnaire (CEQ-C). The data was analyzed utilizing IBM SPSS Statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e \u0026nbsp;Women in the LDRP group experienced shorter time of total labor stage (333.16 min vs 434.88 min, P \u0026lt; 0.01) and first stage of labor (262.87 min vs 360.34 min, P \u0026lt; 0.01). Incidence of intrapartum fever in the LDRP group were lower than those in the control group (P \u0026lt; 0.01). There were no differences in the rates of cesarean section (CS) or postpartum hemorrhage (P \u0026gt; 0.05). Additionally, rates of postpartum infection, neonatal admissions, 5min-Apgar scores, and indications for CS were similar in the two groups (P \u0026gt; 0.05). The mean total CEQ-C score for women in LDRP was 3.48 (SD 0.25). In “Own capacity it was 3.38 (SD 0.40), in “Professional support” it was 3.91 (SD 0.19), in “Perceived safety” it was 3.16 (SD 0.51), and in “Participation” it was 3.22 (SD 0.56). When comparing women in ordinary room, differences were detectable (p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e LDRP can improve the outcome of cervical balloon induction and enhance the experience of childbirth.\u003c/p\u003e","manuscriptTitle":"Cervical Balloon Induction in LDRP Unit: Effects on Maternal and Neonatal Outcomes for Primiparous Women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 19:41:11","doi":"10.21203/rs.3.rs-4166038/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"46cbd9a2-69b1-4a82-b586-520fe4d1fa24","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-28T16:51:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-01 19:41:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4166038","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4166038","identity":"rs-4166038","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}