Title: Evaluate The Effectiveness of Using Nonpharmacological Intervention During
Childbirth: An Improvement Project in Jordanian Maternity Hospitals
Version: 5 Date: 30 Sep 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
N/A - there are no statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: I commend the authors for their attention to each suggestion and
the manuscript is much improved and near ready for publication in my opinion. I hope that this
project is implemented widely across Jordan as their results certainly show that it is feasible and
beneficial to patients. I have some small suggestions for edits.
REQUESTED REVISIONS:
Suggest the authors be consistent with terminology – cesarean birth and vaginal birth would be
the preferred terms vs. “delivery” which has a connotation of the mother being passive in the
birth process
Did the same person provide the intervention (suggesting non-pharmacologic techniques in
labor) and also conducted the interviews? If so, please add that to the limitations.
66 – “push the fetus, ending up with a prolonged second stage” – suggest change to “push
effectively, prolonging second stage labor”
73 – “applicable” or maybe the word you want is “available”?
77 –“ and fetus” – I would take that out because it’s hard to measure satisfaction for the fetus
96 – “In Jordan, antenatal care is almost accessible”
105 – take out “aim”
113 – “cesarean section births” take out “section”
115 – “To help achieve this, a collection of non-pharmacological pain management techniques
would be quite beneficial.” Suggest change to “may be beneficial” because you are
hypothesizing that they would be beneficial but you don’t know that yet
147 – “During labor, the researcher assisted in clarifying things for the mother while she was
cared for by the midwife” – can you be more specific as to what was clarified?
329 – “Some mothers continued to utilize relaxation methods throughout the postpartum period,
which benefited them, their babies, and their families, implying that adopting these skills
established lifelong success.” This is a new and interesting finding from the study and it should
be also included in the results because the discussion/conclusion should not report results that
are not in the results section of the manuscript.
335 – “Non-pharmacological shows coping…” incomplete sentence – suggest “Non-
pharmacological methods are effective in helping with coping…”
341 – “their past values and beliefs” consider editing to “their preferences and beliefs” because
patients may choose something that feels good to them that does not necessarily relate to their
values of beliefs
347 – “We believe that our study is the first study to employ a quality improvement project to
evaluate” – consider editing to “To our knowledge this is the first quality improvement project
to evaluate…”
351 - Eighteen mothers were interviewed, and their responses ranged greatly. – suggest you
take out this sentence because their responses were actually fairly similar in that they very much
liked the comfort measures