Effect of collaborative psychological care on negative emotions, vaginal delivery, and labor duration in primiparas: A retrospective cohort study

Abstract

This study evaluates the effect of collaborative psychological care during childbirth on reducing negative emotions, increasing vaginal delivery rates, and shortening the labor process. A retrospective cohort study was conducted at The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture using medical records from May 2019 to July 2021. A total of 108 primiparas who met the inclusion criteria were identified and categorized into 2 groups based on the type of care received: the conventional group (n = 54) and the study group (n = 54). The conventional group received standard routine care, including environmental support, health education, vital sign monitoring, psychological guidance, and pain management. The study group received collaborative psychological care in addition to routine nursing, which included the selection of a responsible family member, family-based psychological support training, prenatal psychological diary maintenance, environmental modifications, and continuous labor companionship. Negative emotions were assessed using the Symptom Checklist-90, which evaluates 9 dimensions of psychological distress, with higher scores indicating greater distress. Negative emotion scores, vaginal delivery rates, and labor duration were retrospectively analyzed and compared between the 2 groups. Before the intervention, there was no significant difference in negative emotion scores between the 2 groups (P > .05). Before delivery, the negative emotion scores in the study group were significantly lower than those in the conventional group (P < .05). The number of vaginal deliveries in the study group was 50 (92.59%), significantly higher than 38 (70.39%) in the conventional group (P < .05). Additionally, the 1st stage and total duration of labor in the study group were (447.95 ± 53.45) minutes and (498.15 ± 35.14) minutes, respectively, both significantly shorter than those in the conventional group (P < .05). The implementation of collaborative psychological care during childbirth can significantly reduce negative emotions, increase vaginal delivery rates, and shorten the labor process in primiparas. These findings suggest that integrating psychological support into routine obstetric care can improve maternal well-being and promote better delivery outcomes, making it a valuable approach for clinical practice.

1. Introduction

Childbirth is a complex physiological and psychological process influenced by multiple factors. For primiparas, the lack of childbirth experience, combined with the intense pain and stress of labor, often results in significant emotional distress, including fear, anxiety, and depression. Studies have demonstrated that these negative emotions can prolong labor, reduce uterine contractility, and increase the likelihood of cesarean section, ultimately affecting maternal and neonatal outcomes.^[1,2] Despite the well-established impact of psychological well-being on childbirth, routine obstetric care primarily focuses on physiological aspects, with limited emphasis on structured psychological support for primiparas.

Traditional obstetric nursing primarily involves physical monitoring, environmental adjustments, health education, and basic psychological guidance. However, these interventions are often fragmented and insufficient in addressing the dynamic psychological needs of primiparas during labor. Huang et al^[3] highlighted that routine nursing care before delivery lacks comprehensive psychological intervention, making it difficult to effectively alleviate maternal anxiety and improve labor quality. Existing psychological interventions, such as cognitive behavioral therapy (CBT), relaxation techniques, and meditation, have been shown to be highly effective in reducing perinatal anxiety and depression. However, many of these approaches require extensive patient participation or specialized psychological professionals, limiting their feasibility for routine clinical application during labor.^[4] Furthermore, most psychological interventions primarily focus on the prenatal period, with little emphasis on immediate psychological support during the labor process. Given the unpredictability and high emotional stress of labor, a more practical and dynamic psychological support strategy is required to effectively assist primiparas.

Collaborative psychological care has emerged as a promising approach that integrates nursing staff and family members to provide continuous emotional support throughout labor.^[5] This model actively engages both professional caregivers and the patient’s support system to enhance emotional regulation, reduce anxiety, and promote spontaneous vaginal delivery. Unlike conventional psychological interventions, which rely primarily on self-directed coping mechanisms, collaborative psychological care offers real-time, external support tailored to the labor experience. It incorporates guided emotional support, family-based psychological training, prenatal psychological diary maintenance, and continuous labor companionship, ensuring a structured and adaptable psychological intervention.^[6]

Existing psychological interventions have notable limitations that hinder their widespread implementation in obstetric practice. Many techniques, such as CBT and mindfulness training, require prior learning and active patient participation, which may not be feasible during the acute stress of labor. Additionally, interventions that depend on professional psychologists are often impractical in standard obstetric wards due to limited staffing and resources.^[7] The role of family support, which has been shown to significantly reduce labor anxiety and enhance maternal confidence, remains underutilized in conventional psychological care models. By integrating trained family members into the intervention process, collaborative psychological care provides a sustainable and accessible alternative, enhancing maternal emotional resilience without requiring specialized psychological personnel.

This study aims to evaluate the impact of collaborative psychological care on negative emotions, vaginal delivery outcomes, and labor duration in primiparas. By investigating this novel approach, we seek to provide empirical evidence supporting the integration of psychological support into routine obstetric care, ultimately improving maternal well-being and childbirth experiences.

2. Materials and methods

2.1. Research design

This study was approved by the Ethics Committee of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture. A total of 108 primiparas who delivered at our hospital between May 2019 and July 2021 were included.

2.2. Inclusion and exclusion criteria

Inclusion criteria: the participants were primiparas with a singleton full-term pregnancy; transabdominal B-ultrasound confirmed a cephalic presentation, and predelivery assessments indicated eligibility for vaginal delivery; the primiparas had normal communication abilities; during labor, the husband, mother, or other family members provided companionship; the study was approved by the ethics committee, and the participants provided informed consent. Exclusion criteria: primiparas with severe pregnancy complications; primiparas with pre mental disorders; primiparas with severe congenital malformations or those unable to undergo vaginal delivery.

2.3. Research methods

Routine care was given to primiparas in conventional group, including: Environmental intervention: Providing a quiet, comfortable, and clean environment for primiparas to promote relaxation; Health guidance: Educating primiparas and their families on predelivery preparations, the benefits of vaginal delivery, the labor process, and postpartum maternal and neonatal health knowledge; Vital sign monitoring: Regularly monitoring blood pressure, heart rate, and other key indicators of primiparas, while also assessing fetal heart rate to ensure normalcy; Psychological guidance: Delivering personalized psychological support based on the education level of the primipara, addressing their concerns, and encouraging them to opt for vaginal delivery; Pain management and support: Assisting primiparas in getting out of bed safely and providing pain relief techniques such as gentle abdominal touch and lumbosacral massage for those experiencing intense contractions. During pain-free intervals, nutrient-rich foods such as eggs, milk, and chocolate were provided to replenish energy levels.

On the basis of routine nursing care, collaborative psychological nursing was implemented for primiparas in the study group. The specific measures included the following:

2.3.1. Determine the responsible family members

Healthcare providers communicated with the family members of primiparas to select 1 responsible family member who possessed a strong sense of responsibility, good learning ability, and effective communication skills. Typically, the mother or husband of the primipara was chosen to facilitate continuous support and care. The responsible family member was required to accompany the primipara throughout the entire waiting period before delivery, providing emotional support and reassurance.

2.3.2. Intervention measures

The collaborative psychological care intervention in this study is based on CBT, family-centered maternity care, and continuous labor support, all of which have been proven to reduce anxiety and improve childbirth outcomes. Unlike conventional psychological methods that require prior learning or specialized professionals, this model eliminates these barriers, ensuring real-time clinical applicability. By integrating nursing staff and trained family members, it provides continuous emotional support without requiring patients to independently apply psychological techniques, thereby enhancing accessibility and practicality in obstetric care while retaining key psychological benefits. The intervention includes the following components: Training and guidance, Training for responsible family members: One-on-one guidance sessions were conducted for responsible family members, covering topics such as the psychological characteristics of primiparas, common negative emotions, emotional guidance, family support strategies, communication skills, and knowledge related to childbirth; Family training sessions: Every evening, structured training sessions were held for expectant mothers and their families, covering labor and neonatal care knowledge. These sessions included guided discussions on childbirth and childcare skills, enhancing the ability of family members to support primiparas, strengthening family trust, and improving overall family functionality; Delivery room visit: primiparas and their responsible family members were guided on a tour of the delivery room to familiarize them with the layout, medical equipment, and overall environment. This aimed to reduce the sense of unfamiliarity, improve environmental adaptability, and prevent potential delivery-related anxiety. Antenatal psychological diary, Primiparas and their responsible family members were encouraged to maintain a psychological diary before delivery. This diary helped track emotional fluctuations and served as a medium for strengthening communication with the assigned nurse; Nurses analyzed the psychological states and potential causes of negative emotions, implementing targeted interventions to ease distress. For instance, responsible family members were encouraged to help primiparas manage their emotions, while nurses provided professional guidance through distraction techniques, explanations, and enhanced family support, thereby improving maternal compliance with nursing measures. Environmental intervention: In addition to ensuring a clean and quiet labor environment, the ward was personalized based on the primipara’s preferences to enhance comfort and familiarity. Favorite books, decorative items, or preferred foods were placed next to the bed, allowing primiparas to alleviate anxiety and fear by shifting their attention to familiar objects. Continuous labor companionship: Responsible family members accompanied primiparas throughout labor, providing physical and emotional support. During contractions, responsible family members assisted primiparas in adjusting their positions to enhance comfort, provided lumbar-sacral massage to alleviate pain, and continuously offered verbal encouragement to boost confidence in vaginal delivery. During contraction intervals, primiparas were offered appropriate foods based on their eating habits and nutritional needs, combined with encouragement strategies to enhance cooperation and participation in the birthing process.

2.4. Observation indicators

2.4.1. Mental state (negative emotions)

The Mental Health Test Questionnaire (SCL-90)^[8] was used to assess the negative emotions of primiparas both before the intervention and before delivery. This scale consists of 9 dimensions, including somatization, obsessive-compulsive symptoms, and sensitivity. Each dimension is scored on a scale of 1 to 5, with higher scores indicating greater severity of negative emotions. The total score reflects the overall psychological distress level, providing an objective measure of emotional well-being during childbirth.

2.4.2. Rate of vaginal delivery

The incidence rates of cesarean section, assisted delivery, and vaginal delivery among primiparas were recorded and analyzed.

2.4.3. Labor duration

The duration of each stage of labor for primiparas was documented to assess the impact of collaborative psychological care on labor progression.

2.5. Data processing

SPSS 23.0 (IBM SPSS Statistics for Windows, Version 23.0; IBM Corp., Armonk) statistical software was used to input the follow-up data into the database, and the included factors were assigned values. Measurement data with normal distribution were expressed as mean ± standard deviation ($\overline{x}\pm s$), t-test was used for comparison between groups, and enumeration data were expressed as percentage (%) by chi-square test. P < .05 was considered statistically significant.

3. Results

3.1. General information

The age of primiparas ranged from 21 to 35 years, with an average age of (27.69 ± 2.51) years. Gestational age ranged from 37 to 41 weeks, with an average of (38.92 ± 0.57) weeks. Predelivery weight ranged from 54 to 77.5 kg, with an average of (65.98 ± 6.13) kg. In terms of education level, 23 primiparas had a high school (or Technical Secondary School) education, 64 had an undergraduate (or junior college) education, and 21 had a graduate-level education or higher. Based on the principle of baseline data matching, primiparas were divided into the conventional group and the study group, with 54 cases in each group. There was no significant difference in baseline characteristics between the 2 groups (P > .05), as shown in Table 1.

Table 1.

Basic data of primiparas in the 2 groups [($\overline{\mathit{x}}\pm \mathit{s}$), n (%)].

	The study group (n = 54)	The conventional group (n = 54)	χ 2 /t	P
Age (yr)	27.97 ± 2.27	27.40 ± 2.72	1.182	.240
Gestational age (wk)	38.85 ± 0.61	39.01 ± 0.54	1.443	.152
Weight before delivery (kg)	66.28 ± 5.87	65.65 ± 6.42	0.532	.596
Level of education			0.154	.926
Senior High School (Technical Secondary School)	11 (20.37)	12 (22.22)
Undergraduate (Junior College)	33 (61.11)	31 (57.41)
Postgraduate and above	10 (18.52)	11 (20.37)

3.2. Comparison of negative emotions

This study primarily analyzed the SCL-90 scores of the 2 groups before intervention and before delivery. The SCL-90 scale evaluates multiple dimensions of psychological distress, including somatization, obsessive-compulsive symptoms, interpersonal relationships, sensitivity, depression, hostility, fear, paranoia, and mental illness. Before the intervention, the comparison of 2 groups scores indicated no significant difference between the 2 groups (P > .05).

After the intervention, before delivery, the study group’s scores for somatization, obsessive-compulsive symptoms, interpersonal relationships, sensitivity, depression, hostility, fear, paranoia, and mental illness were significantly lower, respectively. In contrast, the conventional group had higher corresponding scores. These findings indicate a significant and statistically meaningful reduction in negative emotions in the study group compared to the conventional group (P < .05), as shown in Table 2.

Table 2.

SCL-90 scores of primiparas in the 2 groups [($\overline{\mathit{x}}\pm \mathit{s}$), point].

	Before the intervention
	The study group (n = 54)	The conventional group (n = 54)	χ2		P
Somatization	3.35 ± 0.41	3.41 ± 0.45	0.724		.471
Forced symptoms	3.52 ± 0.48	3.48 ± 0.44	0.451		.653
Interpersonal relationships	3.08 ± 0.26	3.11 ± 0.29	0.566		.573
Sensitive	3.79 ± 0.37	3.75 ± 0.34	0.585		.560
Depression	3.89 ± 0.52	3.92 ± 0.47	0.315		.754
Hostile	3.23 ± 0.25	3.20 ± 0.29	0.576		.566
Terrorist	3.75 ± 0.46	3.79 ± 0.46	0.452		.652
Paranoid	3.06 ± 0.37	3.09 ± 0.42	0.394		.695
Psychotic	2.81 ± 0.35	2.79 ± 0.41	0.273		.786

	Before delivery
	The study group (n = 54)	The conventional group (n = 54)	χ2	P
Somatization	1.48 ± 0.21	2.21 ± 0.31	14.327	.000
Forced symptoms	1.85 ± 0.32	2.41 ± 0.28	9.678	.000
Interpersonal relationships	1.25 ± 0.18	1.65 ± 0.22	10.341	.000
Sensitive	1.59 ± 0.26	2.11 ± 0.19	11.866	.000
Depression	1.65 ± 0.28	2.26 ± 0.41	9.029	.000
Hostile	1.48 ± 0.19	1.86 ± 0.24	9.122	.000
Terrorist	1.41 ± 0.27	1.88 ± 0.30	11.466	.000
Paranoid	1.18 ± 0.23	1.68 ± 0.27	10.359	.000
Psychotic	1.18 ± 0.25	1.79 ± 0.33	10.827	.000

SCL-90 = Symptom Checklist-90.

3.3. Comparison of delivery modes

This study aimed to examine the vaginal delivery rate among primiparas with different delivery methods. As shown in Figure 1, the number of spontaneous vaginal deliveries, vaginal assisted deliveries, and cesarean sections in the study group was 46, 4, and 4, respectively, resulting in a total vaginal delivery rate of 92.59% (50/54). In contrast, the conventional group had 32 spontaneous vaginal deliveries, 6 vaginal assisted deliveries, and 16 cesarean sections, leading to a total vaginal delivery rate of 70.39% (38/54).

Figure 1.

The vaginal delivery number of primiparous women with different delivery methods.

Through comparative analysis, the data indicate a significant difference in the total vaginal delivery rate between the 2 groups, with the study group showing a notably higher rate. This difference is statistically significant (P < .05), suggesting that collaborative psychological care may effectively promote vaginal delivery.

3.4. Comparison of labor stages

This study aimed to compare the labor duration between the 2 groups of primiparas. As shown in Table 3, the 1st, 2nd, 3rd, and total stages of labor in the study group lasted 447.95 ± 53.45 minutes, 47.46 ± 13.26 minutes, 8.14 ± 5.41 minutes, and 498.15 ± 35.14 minutes, respectively. In contrast, the conventional group had labor durations of 529.42 ± 71.58 minutes, 49.17 ± 15.71 minutes, 9.49 ± 5.98 minutes, and 587.34 ± 49.49 minutes, respectively.

Table 3.

Labor stages of primiparas in 2 groups [($\overline{\mathit{x}}\pm \mathit{s}$), min].

	The study group (n = 54)	The conventional group (n = 54)	χ 2	P
The 1st labor	447.95 ± 53.45	529.42 ± 71.58	6.697	.000
The 2nd labor	47.46 ± 13.26	49.17 ± 15.71	0.611	.542
The 3rd labor	8.14 ± 5.41	9.49 ± 5.98	1.230	.221
Total labor	498.15 ± 35.14	587.34 ± 49.49	10.798	.000

A comparison of these data indicates that the study group experienced significantly shorter 1st stage and total labor durations compared to the conventional group, while the differences in the 2nd and 3rd stages were not statistically significant. The overall reduction in labor duration in the study group is statistically significant (P < .05), suggesting that collaborative psychological care may effectively shorten the labor process and improve delivery outcomes.

4. Discussion

Delivery refers to the process in which a pregnant woman reaches 28 weeks of gestation, and the fetus and its appendages are delivered from the onset of labor to complete expulsion from the mother’s body. During this process, primiparous women often experience significant pain and distress due to their lack of childbirth-related knowledge, leading to negative emotions such as anxiety, depression, and fear. These psychological factors can interfere with the smooth progression of labor and ultimately impact both maternal and neonatal health.^[9] Currently, routine obstetric care primarily focuses on the physical health of the mother and newborn, while psychological needs are often overlooked. This gap in care can result in emotional fluctuations before delivery, potentially affecting the outcome of childbirth. Therefore, it is essential for medical staff to provide timely and effective nursing interventions to enhance childbirth effectiveness and improve the overall comfort of the delivery process.

In clinical practice, routine nursing care is relatively limited in scope, making it less effective in addressing emotional well-being. In contrast, psychological care interventions can help stabilize maternal emotions, reduce psychological stress, and alleviate negative emotions, thereby encouraging a more positive mindset during labor. Psychological care is a nursing model that places a strong emphasis on the mental well-being of postpartum women. It involves comprehensive psychological assessments at different time points, followed by individualized and structured psychological interventions based on the assessment results. These interventions aim to stimulate maternal self-efficacy, enhance mental resilience, and prevent the accumulation of negative emotions, ultimately leading to better nursing outcomes and a more positive childbirth experience. The score of SCL-90 in all dimensions (somatization, fear, depression, etc) in the study group after intervention was significantly lower than that in the conventional group (P < .05), suggesting that collaborative psychological nursing alleviates negative emotions through the following mechanisms: Integration of family support: accompanying the responsible family members throughout the whole process and psychological diary analysis, reducing the cognition of pain disaster, improving somatization, depression and compulsive symptoms; Environmental adaptation intervention: visiting the delivery room and personalized adjustment of the environment (such as the placement of preferred items) reduce strangeness and anxiety, and coordinate guidance between medical and family members to reconstruct labor cognition and alleviate helplessness; Psycho-physiological coordination: Emotional stability may shorten the 1st stage of labor by regulating the secretion of stress hormones, and jointly reflect the “emotion-physiological” positive correlation with the improvement of vaginal delivery rate.

In this study, collaborative psychological nursing was implemented, advocating for active involvement of both primiparas and their family members in the nursing process to form a cohesive care team. By fostering collaboration between nurses, patients, and families, this approach aimed to enhance nursing quality and improve maternal outcomes. The results demonstrated that negative emotions among primiparas significantly improved after the intervention, which can be attributed to the lack of structured psychological support in conventional nursing care. Under the distress of intense labor pain, many primiparas struggle to cooperate with nursing staff, limiting the effectiveness of routine interventions. In this study, the assignment of a responsible family member, typically the mother or husband of the primipara, who provided continuous companionship, significantly enhanced maternal cooperation with nursing measures. The continuous emotional encouragement from responsible family members in daily life effectively alleviated fear of childbirth and contributed to emotional stabilization.^[10–12]

Additionally, family education sessions and health guidance for responsible family members enhanced their understanding of primiparas negative emotions, enabling them to offer more effective psychological support. This strengthened family support, allowing primiparas to feel warmth and reassurance from their families, ultimately relieving psychological stress.^[13–15] Zhang Qiue et al^[16–18] highlighted that most primiparas experience severe tension, anxiety, and distress upon entering the labor room. In this study, predelivery labor room visits and environmental modifications helped primiparas become more familiar with their surroundings, thereby reducing anxiety and promoting emotional stability.

Furthermore, this study also demonstrated that the vaginal delivery rate in the study group was significantly higher, while labor duration was notably shorter than in the conventional group (P < .05). These findings are consistent with the results of Zhang Xiaoying^[19] and other scholars, further confirming that collaborative labor preparation can effectively improve vaginal delivery rates. Zhang Yaqing et al^[20,21] noted that some primiparas opt for cesarean sections due to fear and anxiety, despite the absence of medical indications. In this study, guidance for both primiparas and their responsible family members significantly increased awareness of the benefits of vaginal delivery, thereby reducing the likelihood of cesarean sections. Additionally, enhancing family participation in the delivery care process effectively strengthened family support, while specific interventions boosted primiparas’ confidence in vaginal delivery.^[22–26]

Moreover, Zhong et al^[27] emphasized that collaborative nursing improves the ability of family members and nursing staff to assess and manage primiparas’ psychological states through the use of psychological diaries, laying a foundation for effective interventions. The mental state of a mother before delivery can impact labor progression through the endocrine system. Therefore, collaborative psychological interventions contribute to smoother deliveries, reduce labor time, and decrease the need for cesarean sections.^[28,29]

In conclusion, the implementation of collaborative psychological nursing during labor for primiparas can significantly improve prenatal psychological well-being, increase the rate of vaginal delivery, and shorten labor duration. By enhancing emotional stability and maternal cooperation, this approach helps reduce psychological distress, ultimately minimizing the risk of adverse pregnancy outcomes. Given its effectiveness in improving both psychological and obstetric outcomes, collaborative psychological nursing is a valuable intervention that warrants broader clinical adoption.

Author contributions

Conceptualization: Guangxia Mei, Jing Yang, Weiquan Xie.

Data curation: Guangxia Mei, Jing Yang, Weiquan Xie.

Formal analysis: Guangxia Mei, Jing Yang, Weiquan Xie.

Investigation: Jing Yang.

Methodology: Weiquan Xie.

Writing – original draft: Guangxia Mei, Jing Yang, Weiquan Xie.

Writing – review & editing: Guangxia Mei, Jing Yang, Weiquan Xie.