THE EFFECTS OF MOTHER FRİENDLY PRACTİCES ON MATERNAL AND FETAL OUTCOMES: A MULTİCENTER STUDY
Conditions: Delivery Care, Satisfaction With Care
Sponsor: Sakarya University

 
                                                                                                                                             16.01.2025 
The Effects Of Mother-Friendly Practices On Maternal And Fetal Outcomes: A Multicenter 
Study 
Merve Keskin Paker1, Ayşe Beyaz2, Gülsün Ucar3, Merve Kaplan Kaya3, Zübeyde Kılıc3, Hilal 
Uslu Yuvaci4 
1 Sakarya Training and Research Hospital, Department of Obstetrics and Gynecology, Sakarya, 
Turkey. 
2 Ümraniye Research and Training Hospital, Department of Obstetrics and Gynecology İstanbul , 
Turkey. 
3 Institute of Health Sciences, Department of Midwifery. Sakarya, Türkiye. 
4. Sakarya University School of Medicine, Department of Obstetrics and Gynecology, Sakarya, 
Turkey. 
Merve Keskin Paker: ORCID ID: https://orcid.org/0000-0003-4796-0909 
E mail: mervepaker@sakarya.edu.tr 
Sakarya Training and Research Hospital, Department of Obstetrics and Gynecology, Sakarya, 
Turkey 
Hilal Uslu Yuvaci: ORCID ID: https://orcid.org/0000-0001-8067-3165 
E mail: hilaly@sakarya.edu.tr 
Assoc. Prof. Dr., Sakarya University School of Medicine, Department of Obstetrics and 
Gynecology, Sakarya, Turkey 
Ayşe Beyaz: ORCID ID: 0009-0002-8490-5562 
E mail: aysewien@gmail.com 
Ümraniye Research and Training Hospital, Department of Obstetrics and Gynecology İstanbul , 
Turkey.  
Gülsün Uçar: ORCID ID: 0009-0003-8867-8341 
Institute of Health Sciences, Department of Midwifery. Sakarya, Türkiye. 
E mail: gulsunucar54@gmail.com.tr 
Merve Kaplan Kaya: ORCID ID: 0009-0005-7077-1657 
E mail: mrvekplnkaya@gmail.com 
Zübeyde Kılıç: ORCID ID: 0009-0006-7331-8687 
Institute of Health Sciences, Department of Midwifery. Sakarya, Türkiye. 
E mail: zubeydekilic990@gmail.com 
 
Author Statement 
Merve Keskin Paker :  Conceptualization , Methodology, Validation, Formal analysis, 
Investigation , Resources , Data Curation , Writing - Original Draft , Visualization,  Project 
administration 
Hilal Uslu Yuvaci : Methodology,  Writing - Review & Editing, Supervision  
Ayşe Beyaz: Data Curation, Resources 
Gülsün Uçar: Data Curation,  Resources 
Merve Kaplan Kaya: Data Curation, Resources 
Zübeyde Kılıç: Data Curation, Resources 
 
Corresponding Author: Merve Keskin Paker 
E mail: mervepaker@sakarya.edu.tr 
Cell Phone: +90 532 3977308  
Adress: Sakarya University School of Medicine, Department of Obstetrics and Gynecology, Adnan 
Menderes Street, Merkez Campus Sakarya, TURKEY, 54100 
Financial disclaimer/conflict of interest: None 
 
 

 
                                                                                                                                             16.01.2025 
STUDY PROTOCOL 
This study was designed as a prospective, multicenter, randomized controlled trial to evaluate the 
effects of mother-friendly practices on maternal and fetal outcomes. The study was conducted 
between February 2025 and June 2025 in two tertiary care hospitals with different models of obstetric 
care. Sakarya Training and Research Hospital, designated as a mother-friendly hospital, provided 
care based on a model emphasizing minimal intervention, continuous support, and improved physical 
conditions, whereas Ümraniye Training and Research Hospital provided standard obstetric care. 
A total of 281 primiparous women with singleton term pregnancies (≥37 weeks) were enrolled. 
Participants were randomly assigned in a 1:1 ratio to either the mother-friendly care group or the 
standard care group using a sequentially numbered, sealed-envelope method to ensure allocation 
concealment. Due to the nature of the intervention, blinding of participants and healthcare providers 
was not feasible. 
In the intervention group, participants received care in single-occupancy labor rooms, were allowed 
continuous companion support, and were encouraged to use non-pharmacological pain relief methods 
such as massage, warm compresses, music therapy, and aromatherapy, along with minimal medical 
intervention. In the control group, participants received routine obstetric care, including standard 
monitoring and conventional labor management practices. 
Data were prospectively collected by attending midwives and physicians using standardized forms. 
Recorded variables included maternal age, education level, gestational week at admission, cervical 
dilation, childbirth education status, labor interventions (e.g., enema, episiotomy, vacuum, forceps), 
and use of non-pharmacological methods. Maternal outcomes included mode of delivery, postpartum 
hemorrhage, duration of labor, and pain scores measured using the Visual Analog Scale (VAS) during 
latent and active labor phases. Neonatal outcomes included birth weight, Apgar scores, and NICU 
admission. Maternal satisfaction was assessed using the validated Scale for Measuring Maternal 
Satisfaction in Birth within the first postpartum hour. 
The primary outcome of the study was a composite maternal and neonatal outcome, including 
cesarean delivery, postpartum hemorrhage, low Apgar score (<7 at 5 minutes), and NICU admission. 
Secondary outcomes included mode of delivery, duration of labor, episiotomy rate, instrumental 
delivery, pain scores, and maternal satisfaction. 
The study was conducted in accordance with the principles of the Declaration of Helsinki and 
approved by the Sakarya University Clinical Research Ethics Committee. Written informed consent 
was obtained from all participants prior to enrollment. 
 
 STATISTICAL ANALYSIS PLAN  
Statistical analyses were performed using SPSS version 22. Descriptive statistics were presented as 
mean ± standard deviation for continuous variables and as frequencies and percentages for categorical 
variables. The normality of continuous variables was assessed using the Kolmogorov–Smirnov test. 
For comparisons between the two groups, the independent samples t-test was used for normally 
distributed variables, while the Mann–Whitney U test was applied for non-normally distributed 
variables. Categorical variables were compared using Pearson’s chi-square test. For comparisons 
involving more than two groups, the Kruskal–Wallis test was used. 
Correlation analyses between continuous variables were performed using Spearman’s rank 
correlation coefficient. A two-tailed p-value of <0.05 was considered statistically significant. 
To further strengthen the analysis, multivariate regression models were planned to adjust for potential 
confounding variables, including maternal age, education level, and labor-related factors. The results 
of regression analyses were reported as odds ratios (ORs) with 95% confidence intervals (CIs). 
Missing data were handled using complete-case analysis. Sensitivity analyses were considered to 
evaluate the robustness of the findings. 
 
 

 
                                                                                                                                             16.01.2025 
INFORMED CONSENT STATEMENT  
 
Participants were informed in detail about the purpose and procedures of the study conducted by Dr. 
Merve Keskin Paker at the Department of Obstetrics and Gynecology of Sakarya Training and 
Research Hospital. Following this explanation, eligible individuals were invited to participate as 
study subjects. 
All participants were assured that their personal and medical information would be treated with strict 
confidentiality and respect, and that all data obtained during the study would be used solely for 
scientific and educational purposes. Adequate assurance was provided regarding the protection of 
personal data. 
Participants were informed that they could withdraw from the study at any time without providing 
any reason, and that their decision to participate or not would not affect their medical care or their 
relationship with healthcare providers. Additionally, participants could be excluded from the study 
by the researchers if deemed necessary, provided that no harm would occur to their medical condition. 
No financial burden was imposed on participants for study-related procedures, and no financial 
compensation was provided. Participants were also informed that, in the event of any health problems 
arising directly or indirectly from the study, all necessary medical care would be provided without 
any cost. 
Contact information of the principal investigator was provided, allowing participants to reach the 
research team at any time in case of questions or health concerns during the study. 
All participants confirmed that they had received both written and verbal information, had sufficient 
time to consider participation, fully understood the study, and voluntarily agreed to participate 
without any coercion. A signed copy of the informed consent form was provided to each participant.