Abstract
Background
Labor pain and maternal comfort during childbirth can influence women’s childbirth experience, labor progress, and psychological well-being. Non-pharmacological interventions are increasingly used to support labor pain management in a safe and supportive manner. Quran recitation, a culturally familiar auditory intervention for Muslim women, may help reduce pain perception and promote relaxation during labor. This study aims to examine the effect of listening to Quran recitation on labor pain, childbirth comfort, and blood pressure among nulliparous women in Oman.
Methods
A quasi-experimental study was conducted at Khoula Hospital, Oman, among 120 nulliparous women with singleton term pregnancies in active labor. Participants were allocated into two groups: a Quran recitation group (n = 60) and a back massage group (n = 60). Women in the intervention group listened to a recorded Quran recitation during labor, while the comparison group received a standardized back massage. Labor pain intensity was assessed using the Visual Analogue Scale (VAS), pain behavior using the Pain Behavioral Observation Scale (PBOS-3), and childbirth comfort using the Childbirth Comfort Questionnaire (CCQ). Systolic and diastolic blood pressure were also recorded. Measurements were obtained before and after the intervention. Data were analyzed using paired t-tests, independent t-test, chi-square, and multivariate linear regression.
Results
Women in the Quran recitation group showed a significant reduction in mean VAS pain scores, decreasing from 76.45 ± 8.20 before the intervention to 58.32 ± 7.16 after the intervention (p < 0.001). In contrast, the back massage group showed no statistically significant change (62.88 ± 8.44 to 61.10 ± 7.98; p > 0.05). The Quran recitation group also demonstrated significantly improved pain behavior and higher overall childbirth comfort scores (CCQ total score, p = 0.002). Multivariate linear regression analysis showed that Quran recitation was significantly associated with lower systolic (β = − 0.53, p < 0.001) and diastolic blood pressure (β = − 0.49, p < 0.001) after adjustment for gestational age, time of admission, and prior Quran exposure.
Conclusion
Quran recitation was associated with reduced labor pain, improved childbirth comfort, and lower blood pressure among nulliparous women during labor. As a culturally acceptable non-pharmacological intervention, it may support more holistic maternity care for Muslim women.
Introduction
Childbirth is widely recognized as a major life event with profound psychological significance in a woman’s life. It has been described as a transformative experience that can foster personal growth, resilience, and a sense of achievement. Positive childbirth experiences are often characterized by a sense of control, active participation, and deep emotional engagement, which may result in lasting feelings of satisfaction and empowerment. From this perspective, childbirth can represent a meaningful and life-enhancing event [1].
However, contemporary evidence indicates that childbirth is not universally experienced as positive. For a substantial proportion of women, it may be perceived as distressing or even traumatic, potentially leading to adverse psychological outcomes, including childbirth-related post-traumatic stress disorder (PTSD) [2]. Globally, up to 50% of women report their childbirth experience as traumatic, with approximately 3–17% developing childbirth-related PTSD and 1.5–6% meeting the criteria for clinically diagnosed PTSD [3].
In parallel, there has been a notable increase in medicalized childbirth practices. In Oman, for example, cesarean section (CS) rates have risen steadily from 15.72% in 2009 to 21.7% in 2020, reaching approximately 26% in 2024 [4]. While such interventions are often necessary, their increasing prevalence underscores the importance of examining factors that influence women’s childbirth experiences.
Traumatic childbirth has been associated with multiple factors, including unexpected medical complications, emergency or assisted delivery, lack of perceived control during labor unmet expectations, and pre-existing psychological vulnerabilities. The consequences extend beyond the immediate postpartum period, encompassing both physical and psychological domains. Physical effects may include prolonged pain, delayed wound healing, fatigue, sleep disturbances, and breastfeeding difficulties [5]. Psychological consequences are often more enduring and may include tokophobia, postpartum depression, anxiety, PTSD, impaired mother–infant bonding, and increased parenting stress [6].
Although pharmacological methods such as epidural analgesia and nitrous oxide remain the gold standard for labor pain relief, they are not without limitations, including potential side effects such as hypotension, prolonged labour, and increased rates of instrumental delivery. This has led to growing interest in complementary, non-pharmacological approaches that may enhance women’s childbirth experiences while minimizing intervention-related risks.
Despite extensive research on negative childbirth outcomes, comparatively less attention has been given to understanding and promoting positive childbirth experiences. Evidence suggests that factors such as continuous support, effective communication with healthcare providers, a sense of autonomy, and partner involvement contribute significantly to positive outcomes. In this context, non-pharmacological pain management strategies—including relaxation techniques, breathing exercises, massage, positioning, and supportive care play a crucial role in improving women’s comfort, emotional well-being, and sense of control during labor [7]. These approaches can reduce pain perception and fear, while encouraging active participation in the birthing process, thereby fostering a more positive and empowering experience [8, 9].
In culturally specific settings such as Oman, women’s preferences for labor support are strongly influenced by social and cultural norms. Quran recitation is widely accepted as a familiar and comforting auditory intervention, particularly during stressful situations such as labor, whereas other auditory methods, such as music, may be less culturally preferred.
Within this context, Quran recitation may promote psychological comfort by reducing anxiety and enhancing emotional stability, while back massage may provide physical relief through sensory stimulation and improved circulation. Although the precise physiological mechanisms were not directly examined in the present study, existing evidence suggests that such interventions can influence pain perception and stress responses, thereby contributing to improved childbirth experiences [10].
Importantly, these non-invasive and low-risk interventions, including Quran recitation, may reduce reliance on pharmacological methods and unnecessary medical interventions, thereby supporting a more natural childbirth process. Quran recitation holds particular importance for Muslim women, as it may provide spiritual reassurance, emotional comfort, relaxation, and a sense of inner peace during labor. By promoting calmness and reducing anxiety, Quran recitation may help women cope more effectively with labor pain and enhance their overall childbirth experience. Positive childbirth experiences have been linked to improved maternal self-esteem, better postnatal functioning, and stronger mother–infant bonding [11, 12].
Similarly, back massage may help reduce pain perception, muscle tension, and anxiety by promoting physical comfort and maternal relaxation. Together, these interventions may enhance women’s coping ability during labor and contribute to a more positive childbirth experience. Positive childbirth experiences have been linked to improved maternal self-esteem, better postnatal functioning, and stronger mother–infant bonding [13].
These outcomes align with Antonovsky’s salutogenic framework [14], which emphasizes the promotion of health and well-being through strengthening individual coping resources rather than focusing solely on disease and risk. Within this framework, interventions such as Quran recitation and back massage may represent valuable strategies for enhancing positive childbirth experiences [15, 16].
To our knowledge, limited research has directly compared culturally relevant non-pharmacological interventions within the Omani maternity care context, particularly with simultaneous evaluation of multiple maternal outcomes such as pain intensity, behavioral pain responses, childbirth comfort, and blood pressure. Given that childbirth practices in Oman often integrate clinical care with cultural and spiritual traditions, investigating these interventions is both contextually important and clinically relevant. Addressing this gap may support the development of culturally sensitive, evidence-based non-pharmacological pain management strategies in maternity care units. This study aimed to assess the effects of listening to Quran recitation and back massage on labor pain intensity, childbirth comfort, and blood pressure among nulliparous women in Oman.
Methods
Study design and setting
This study employed a prospective quasi-experimental, non-randomized, time-sequential two-group design to evaluate the effects of listening to Quran recitation and the effect of back massage on labor pain, childbirth comfort, and blood pressure among nulliparous women undergoing normal vaginal delivery. The study was conducted between 2020 and 2022 at Khoula Hospital, Oman, a tertiary care facility managing approximately 100 deliveries per month.
Participant’s allocation
Eligible participants were recruited consecutively upon admission to the labor ward after confirming eligibility criteria and obtaining informed consent. Due to logistical constraints and the nature of the interventions, randomization was not feasible. Therefore, participants were allocated sequentially based on the recruitment period. Women recruited during the first four months listened to a Quran recitation, whereas those recruited subsequently received a back massage.
This time-based allocation approach facilitated the consistent implementation of each intervention and minimized potential contamination between groups, particularly considering the auditory and tactile nature of the interventions. To reduce potential time-related confounding, all participants were recruited from the same maternity unit under stable clinical practices, and identical data collection procedures were maintained throughout the study period. Baseline sociodemographic and obstetric characteristics were assessed to examine the similarity of participants across the study phases.
Sample size
The sample size was calculated using G*Power software (version 3.1) based on effect size estimates derived from previous literature. Assuming a medium effect size of 0.50, a significance level (α) of 0.05, and a statistical power of 80% for a two-tailed test, the required total sample size was estimated to be 120 participants [17].
Sampling procedure
A convenience sampling technique was used to recruit eligible participants. Nulliparous women who met the inclusion criteria were enrolled consecutively. Participants were assigned sequentially according to the study period, with the first “60 eligible women allocated to the Quran recitation interventional group, followed by the subsequent 60 women allocated to the back massage interventional group”. Baseline maternal characteristics, including age, gestational age, and other relevant clinical variables, were recorded to assess group comparability and enhance the internal validity of the study.
Study participants
Eligible participants were Omani nulliparous women with singleton term pregnancies (≥ 36 weeks of gestation) who were admitted for normal vaginal delivery during either the latent or active phase of labor and had attended regular antenatal follow-up. Women were excluded if they had any medical or psychological disorders, obstetric complications, or required an emergency cesarean section. Additional exclusion criteria included conception through assisted reproductive technologies, use of analgesics, opioids, or antipsychotic medications, and the presence of visual or hearing impairments. Women who had received any other pain management interventions before or during labour were also excluded.
Data collection tools
Five tools were used for data collection:
Tool 1: sociodemographic and obstetric characteristics questionnaire
This researcher-developed tool, based on an extensive literature review, was used to collect baseline participant information [18]. It comprised two sections: the first covered sociodemographic variables, including maternal age, education level, employment status, and family structure; the second included obstetric characteristics such as gestational age, stage of labor at admission (latent or active phase). These variables were selected for their potential influence on labour pain perception, coping behaviours, and childbirth outcomes. Experts in obstetrics and maternity nursing reviewed the tool to ensure clarity and content validity.
Tool 2: Visual Analogue Scale (VAS)
The Visual Analogue Scale (VAS) was used to assess labor pain intensity. It consists of a 100-mm horizontal line anchored by “no pain” (0 mm) and “worst imaginable pain” (100 mm). Participants were asked to mark the point that best represented the intensity of their perceived pain during uterine contractions. The distance from the “no pain” anchor to the marked point was measured in mm, producing a continuous score from 0 to 100. The VAS is a widely recognized, reliable, and sensitive tool for measuring subjective pain intensity in clinical and research settings [19].
Tool 3: Pain Behavioral Observation Scale (PBOS-3)
The Pain Behavioral Observation Scale (PBOS-3) was used to assess observable pain-related behaviors during labor. The scale evaluates five behavioral domains: vocalization, body movement, breathing control, facial expression, and communication. Each domain is rated using a 3-point scale, where 1 indicates severe pain-related behavior and 3 indicates minimal pain-related behavior. The total raw PBOS-3 score ranges from 5 to 15, with higher scores indicating better behavioral coping and reduced observable pain expression. For analysis, domain scores were summarized and transformed into continuous scores, with higher values reflecting more favorable pain-related behavioral responses [20].
Tool 4: Childbirth Comfort Questionnaire (CCQ)
Childbirth comfort was assessed using the Childbirth Comfort Questionnaire (CCQ), adapted from Kolcaba’s General Comfort Questionnaire based on the Theory of Comfort. The instrument consists of 15 items measured on a five-point Likert scale ranging from strongly disagree to strongly agree. It assesses comfort across four domains: physical, psychospiritual, environmental, and sociocultural contexts, encompassing aspects such as relief, ease, and transcendence. The questionnaire includes both positively and negatively worded items to minimize response bias. Higher scores indicate greater perceived comfort during childbirth [21].
Tool 5: physiological measurement
Maternal blood pressure was measured using a calibrated Omron 705IT digital blood pressure monitor (model HEM-759-E). To ensure accuracy, readings were routinely cross-checked with a standard mercury sphygmomanometer. Blood pressure measurements were recorded at two stages of active labor (4–6 cm and 7–9 cm cervical dilatation), both before and after the intervention, under standardized conditions.
Description of the intervention
Upon admission to the labor room, baseline assessments of pain intensity, pain-related behaviors, and maternal blood pressure were obtained. Measurements were recorded during three consecutive uterine contractions, each lasting approximately 30 to 60 s, with blood pressure measured immediately after each contraction. The mean of the three readings was used for analysis.
Participants in the Quran listening group then received a structured non-pharmacological intervention consisting of listening to recitations from the Holy Quran, namely Surah Maryam, for 15 min, followed by Surah Al-Inshiqaq for 15 min, in a calm and quiet environment. These chapters were selected based on recommendations from Islamic scholars. The recitation was delivered at a standardized volume using the same device for all participants [22, 23].
Participants in the back massage group received a 30-min massage administered according to Kimber’s protocol [24]. This consisted of 15 min of massage over the thoracic region (T10), followed by 15 min over the sacral region (S4). The massage was performed without oil, using standardized pressure and rhythmic movements by a trained researcher under the supervision of the obstetric care team.
Post-intervention assessments of pain intensity, pain-related behaviors, and maternal blood pressure were repeated in both groups during subsequent uterine contractions using the same instruments. Additionally, maternal comfort was assessed at two hours postpartum using the Childbirth Comfort Questionnaire (CCQ).
Due to the nature of the interventions, blinding of participants and assessors was not feasible. To minimize observer bias, behavioral assessments were conducted by trained midwives using standardized scoring criteria.
Ethical considerations
Ethical approval for this study was obtained from the Research and Ethics Committee of Khoula Hospital, Oman, and the Research and Ethical Review and Approval Committee (RERAC) of the Ministry of Health, Oman (Approval Code: PRO 0092019043B). All participants received a full explanation of the study’s purpose, procedures, potential risks, and benefits prior to providing informed written consent. Participant confidentiality and data privacy were strictly maintained throughout the study. Written informed consent to participate was obtained from all participants prior to enrollment.
Statistical analysis
Data were analyzed using IBM SPSS Statistics for Windows, version 27.0. Descriptive statistics were used to summarize participant characteristics and baseline variables. Continuous variables were presented as means ± standard deviations (SD), while categorical variables were presented as frequencies and percentages. Within-group comparisons of pre- and post-intervention outcomes were conducted using paired t-tests. Between-group differences (Quran recitation versus control group) were analyzed using independent samples t-tests. Categorical variables were analyzed using the chi-square test.
Multivariate linear regression analysis was performed to assess the independent effect of Quran recitation on post-intervention pain intensity, childbirth comfort, and blood pressure outcomes, adjusting for potential confounders including gestational age, time of admission, and prior Quran exposure.
Parametric tests were applied under the assumption of approximate normal distribution of the data, supported by the sample size and consistency with similar studies in the literature. All statistical tests were two-tailed, and a p-value of less than 0.05 was considered statistically significant.
Results
Baseline characteristics between groups
A total of 120 nulliparous women were included in the study, with 60 participants in the Quran recitation group and 60 in the back massage group. As shown in Table 1, the two groups were comparable with respect to baseline sociodemographic and obstetric characteristics, including age, educational level, employment status, gestational age, time of admission to the labor room, type of delivery, and family structure. No statistically significant differences were observed between the groups for any of these variables (all p > 0.05).
Table 1.
Sociodemographic and obstetric characteristics of nulliparous women delivered at Khoula Hospital, Oman, 2020–2022
| Variables | Quran Recitation n = 60 (%) | Back massage n = 60 (%) | χ2 test | p- value |
|---|---|---|---|---|
| Age (years) | 4.68 | 0.197 | ||
| 20–24 | 15 (25.0) | 20 (33.3) | ||
| 25–29 | 26 (43.3) | 30 (50.0) | ||
| 30–34 | 10 (16.7) | 7 (11.7) | ||
| _ ≥ 35 | 9 (15.0) | 3 (5.0) | ||
| Mother’s education level | 4.43 | 0.109 | ||
| Up to 12th grade | 20 (33.3) | 24 (40.0) | ||
| Graduate | 25 (41.7) | 28 (46.7) | ||
| Postgraduate and above | 15 (25.0) | 8 (13.3) | ||
| Mother’s employment status | 1.21 | 0.270 | ||
| Employed | 34 (56.7) | 28 (46.7) | ||
| Not employed | 26(43.3) | 32(53.3) | ||
| Gestational age (weeks) | 0.13 | 0.714 | ||
| 36–37 weeks | 28 (46.7) | 26(43.3) | ||
| 38–40 weeks | 32 (53.3) | 34 (56.7) | ||
| Time of admission to the delivery room | 0.24 | 0.620 | ||
| Latent phase | 49 (81.7) | 51 (85.0) | ||
| Active phase | 11(18.3) | 9 (15.0) | ||
| Type of delivery | 1.34 | 0.250 | ||
| Vaginal birth without episiotomy | 38(63.3) | 35(58.3) | ||
| Vaginal birth with episiotomy | 22(36.7) | 25(41.7) | ||
| Family structure | 0.36 | 0.550 | ||
| Nuclear | 50 (83.3) | 52(86.7) | ||
| Extended | 10(16.7) | 8 (13.3) | ||
Values are expressed as frequencies and percentages. The χ2 test was applied to compare groups
*p < 0.05 was considered statistically significant
Comparison of labor pain intensity responses before and after the intervention within each group
Table 2 shows that the Quran recitation group experienced a statistically significant reduction in labor pain intensity following the intervention, with the mean VAS score decreasing from 76.45 ± 8.20 before the intervention to 58.32 ± 7.16 after the intervention (t = 5.67, p = 0.001). In contrast, the back massage group showed only a slight reduction in mean VAS score, from 62.88 ± 8.44 to 61.10 ± 7.98, and this change was not statistically significant (t = 1.02, p = 0.312).
Table 2.
Comparison of Visual Analogue Scale (VAS) score for labor pain before and after the intervention
| Group | Before Intervention (Mean ± SD) | After Intervention (Mean ± SD) | t | p-value |
|---|---|---|---|---|
| Quran Recitation | 76.45 ± 8.20 | 58.32 ± 7.16 | 5.67 | 0.001* |
| Back Massage (Control) | 62.88 ± 8.44 | 61.10 ± 7.98 | 1.02 | 0.312 |
Data are expressed as mean ± standard deviation. VAS = Visual Analogue Scale (0 = no pain, 100 = worst imaginable pain). A paired t-test was applied to compare pre- and post-intervention scores
*Statistically significant at p < 0.05
Comparison of pain-related behavioral responses after the intervention within each group
Table 3 shows the pre- and post-intervention pain-related behavioral responses in both groups. In the Quran recitation group, significant improvements were observed in vocalization, body movement, breathing control, facial expression, and communication after the intervention. The greatest improvements were noted in breathing control and communication. In the back massage group, body movement showed a significant change after the intervention; however, this reflected a decrease in the score, indicating a less favorable behavioral response in this domain. Changes in vocalization, breathing control, facial expression, and communication were not statistically significant. Overall, Quran recitation was associated with more consistent improvement in pain-related behavioral responses compared with back massage.
Table 3.
Pain Behavioral Observation Scale (PBOS-3) scores before and after the intervention (with CI and effect size)
| Domain | Group | Pre (Mean ± SD) | Post (Mean ± SD) | t (df) | p-value | 95% CI | Cohen’s d |
|---|---|---|---|---|---|---|---|
| Vocalization | Quran | 26.83 ± 3.88 | 28.31 ± 3.52 | 2.08 (59) | 0.042* | [0.50, 2.46] | 0.36 |
| Back Massage | 27.89 ± 3.80 | 28.40 ± 3.49 | 1.25 (59) | 0.216 | |||
| Body Movement | Quran | 32.31 ± 3.52 | 33.60 ± 3.22 | 2.19 (59) | 0.032* | [0.03, 2.57] | 0.37 |
| Back Massage | 32.88 ± 3.67 | 30.61 ± 3.10 | 5.86 (59) | < 0.001* | |||
| Breathing Control | Quran | 27.66 ± 3.90 | 31.70 ± 3.02 | 4.04 (59) | < 0.001* | [2.09, 5.82] | 0.31 |
| Back Massage | 34.45 ± 1.81 | 35.45 ± 4.32 | 1.56 (59) | 0.124 | |||
| Facial Expression | Quran | 26.95 ± 3.81 | 29.60 ± 3.01 | 2.45 (59) | 0.017* | [0.83, 4.53] | 0.49 |
| Back Massage | 26.86 ± 3.88 | 25.89 ± 3.88 | 1.30 (59) | 0.199 | |||
| Communication | Quran | 27.77 ± 3.90 | 31.60 ± 3.02 | 4.02 (59) | < 0.001* | [2.01, 5.38] | 0.77 |
| Back massage | 34.45 ± 1.81 | 35.45 ± 4.32 | 1.56 (59) | 0.124 |
PBOS-3 = Pain Behavioral Observation Scale
Higher PBOS 3 scores indicate better behavioral coping and reduced pain expression. Data are presented as mean ± SD. Paired t-tests were used for within-group pre- and post-intervention comparisons. A p < 0.05 was considered statistically significant
Comparison of Childbirth Comfort Questionnaire (CCQ) scores after intervention between groups
As shown in Table 4, women in the Quran recitation group reported significantly higher overall childbirth comfort scores than those in the back massage group (34.13 ± 3.47 vs. 30.05 ± 3.77, p = 0.002). Significant between-group differences were also observed for sociocultural comfort (22.00 ± 2.21 vs. 19.83 ± 2.37, p = 0.002), relief (22.60 ± 2.21 vs. 18.93 ± 2.37, p = 0.002), and transcendence (12.03 ± 1.67 vs. 11.23 ± 1.43, p = 0.025), with higher scores in the Quran recitation group. However, no statistically significant differences were found between the groups in physical comfort, psychospiritual comfort, or environmental comfort (p > 0.05). These findings suggest that Quran recitation was associated with improved overall childbirth comfort, particularly in the sociocultural, relief, and transcendence dimensions.
Table 4.
Comparison of childbirth comfort questionnaire (CCQ) scores after intervention between groups (with CI and effect size)
| Comfort Domain | Quran Group (Mean ± SD) | Back Massage Group (Mean ± SD) | p-value | 95% CI (Between-group) | Cohen’s d |
|---|---|---|---|---|---|
| Total Comfort Score | 34.13 ± 3.47 | 30.05 ± 3.77 | 0.002* | [1.47, 6.74] | 1.13 |
| Physical Comfort | 13.01 ± 1.85 | 12.20 ± 2.17 | 0.0678 | [–0.06, 1.65] | 0.41 |
| Psychospiritual Comfort | 5.46 ± 1.30 | 5.00 ± 2.11 | 0.625 | [–0.74, 1.65] | 0.26 |
| Environmental Comfort | 12.43 ± 1.59 | 11.63 ± 1.65 | 0.085 | [–0.12, 1.68] | 0.49 |
| Sociocultural Comfort | 22.00 ± 2.21 | 19.83 ± 2.37 | 0.002* | [0.80, 3.55] | 0.94 |
| Relief | 22.60 ± 2.21 | 18.93 ± 2.37 | 0.002* | [1.55, 5.04] | 1.59 |
| Transcendence | 12.03 ± 1.67 | 11.23 ± 1.43 | 0.025* | [0.10, 1.50] | 0.51 |
Values are presented as mean ± standard deviation (SD). The p-values indicate between-group comparisons between the Quran recitation group and the control group
*p < 0.05 was considered statistically significant
Changes in blood pressure after the intervention
As shown in Table 5, maternal blood pressure was assessed at cervical dilations of 4–6 cm and 7–9 cm before and after Quran recitation. In the Quran recitation group, both systolic and diastolic blood pressure decreased after the intervention at both stages of cervical dilation. At 4–6 cm dilation, systolic blood pressure decreased from 115.40 ± 11.70 mmHg to 100.80 ± 8.99 mmHg, while diastolic blood pressure decreased from 88.31 ± 6.45 mmHg to 77.92 ± 9.83 mmHg. At 7–9 cm dilation, systolic blood pressure decreased from 135.75 ± 8.51 mmHg to 127.69 ± 7.63 mmHg, and diastolic blood pressure decreased from 90.00 ± 4.73 mmHg to 80.66 ± 6.76 mmHg. These findings indicate a favorable reduction in maternal blood pressure following Quran recitation during labor (Fig. 1).
Table 5.
Changes in maternal blood pressure before and after Quran recitation during labor
| Cervical Dilatation | Blood Pressure Parameter | Before Intervention Mean ± SD | After Intervention Mean ± SD | Mean Reduction | Percentage Reduction |
|---|---|---|---|---|---|
| 4–6 cm | Systolic BP | 115.40 ± 11.70 mmHg | 100.80 ± 8.99 mmHg | 14.60 mmHg | 12.7% |
| 4–6 cm | Diastolic BP | 88.31 ± 6.45 mmHg | 77.92 ± 9.83 mmHg | 10.39 mmHg | 11.8% |
| 7–9 cm | Systolic BP | 135.75 ± 8.51 mmHg | 127.69 ± 7.63 mmHg | 8.06 mmHg | 5.9% |
| 7–9 cm | Diastolic BP | 90.00 ± 4.73 mmHg | 80.66 ± 6.76 mmHg | 9.34 mmHg | 10.4% |
Fig. 1.
Comparison of blood pressure changes during labor experimental vs. control group
Multivariate linear regression analysis
Table 6 presents the findings of the multivariate linear regression analyses adjusted for gestational age, time of admission, and prior Quran exposure. After adjustment, Quran recitation remained a significant predictor of lower post-intervention pain intensity (β = − 0.61, p < 0.001). Quran recitation was also a significant positive predictor of overall childbirth comfort (β = 0.48, p = 0.003). Regarding the CCQ dimensions, significant positive associations were observed for sociocultural comfort (β = 0.51, p = 0.004), relief (β = 0.55, p = 0.002), and transcendence (β = 0.42, p = 0.018), whereas associations with physical comfort, psychospiritual comfort, and environmental comfort were not statistically significant (p > 0.05). In addition, Quran recitation was a significant predictor of lower systolic blood pressure (β = − 0.53, p < 0.001) and lower diastolic blood pressure (β = − 0.49, p < 0.001).
Table 6.
Multivariate linear regression analyses adjusting for gestational age, time of admission, and prior Quran exposure
| Outcome Variable | Predictor (Quran Recitation vs. Back Massage) | Standardized β Coefficient | p-value |
|---|---|---|---|
| Post-intervention pain intensity (VAS) | Quran recitation | –0.61 | < 0.001 |
| Childbirth comfort (total CCQ score) | Quran recitation | 0.48 | 0.003 |
| CCQ Subdomains | |||
| Physical comfort | Quran recitation | 0.23 | 0.078 |
| Psychospiritual comfort | Quran recitation | 0.29 | 0.056 |
| Environmental comfort | Quran recitation | 0.18 | 0.104 |
| Sociocultural comfort | Quran recitation | 0.51 | 0.004 |
| Relief | Quran recitation | 0.55 | 0.002 |
| Transcendence | Quran recitation | 0.42 | 0.018 |
| Systolic blood pressure | Quran recitation | –0.53 | < 0.001 |
| Diastolic blood pressure | Quran recitation | –0.49 | < 0.001 |
Discussion
The present study aimed to evaluate the effects of listening to the Holy Quran and back massage on labor pain intensity, pain-related behaviors, childbirth comfort, and maternal blood pressure among Omani nulliparous women during labor. The findings showed that the Quran-listening group had more favorable outcomes, including lower labor pain intensity, more positive pain-related behavioral responses, greater childbirth comfort, and lower systolic and diastolic blood pressure.
The present findings are consistent with previous research indicating that Quran recitation and other non-invasive auditory interventions may help reduce labor pain and pain frequency among women who listened to the Quran during labour or cesarean section. Taken together, these findings suggest that Quran recitation may promote the calming and comforting effects of Quran listening [25, 26].
In the Islamic context, the Holy Quran is widely regarded as a source of comfort and healing. Listening to selected Surahs, such as Surah Maryam and Surah Al-Inshiqaq, may help women cope more effectively with the intensity of labor pain by fostering a sense of emotional comfort, spiritual reassurance, and acceptance. From a faith-based perspective, enduring pain may be viewed as an experience that encourages greater patience, resilience, and surrender to the will of Almighty Allah, which may support psychological coping during labor.
Regarding pain behavior, the present study found that women in the Quran group showed significantly improved pain-related behavioral responses, reflected by higher PBOS-3 scores after the intervention. Listening to selected Surahs may have offered reassurance, familiarity, emotional comfort, and spiritual support during contractions, which may have helped women respond more positively to labor pain. From a faith-based perspective, sincere prayer and surrender to Allah may also promote patience, trust, and inner calm, thereby supporting coping behaviors during painful experiences. This interpretation is consistent with Antonovsky’s salutogenic framework, which emphasizes the strengthening of coping resources and the promotion of well-being [27, 28].
The present study demonstrated higher overall childbirth comfort in the Holy Quran group following the intervention, with significant improvements particularly in the sociocultural, relief, and transcendence domains. These findings may indicate that Quran recitation offered culturally relevant reassurance, emotional support, and inner comfort during labor. This interpretation is in line with Kolcaba’s theory of Comfort [29], which highlights relief, ease, and transcendence as central components of holistic well-being. Consistent with earlier studies, spiritual practices such as prayer and Quran recitation, as well as other non-pharmacological interventions, have been associated with reduced pain and anxiety and improved comfort across clinical contexts [30, 31]. In labor such effects may support women’s ability to cope more positively with the childbirth experience.
In relation to maternal hemodynamic parameters, the present study found that systolic and diastolic blood pressure decreased after Quran recitation at both stages of cervical dilation. This reduction may suggest that Quran listening contributed to relaxation, emotional reassurance, and improved physiological adaptation during labor.
As previous studies suggest that, for Muslim women, listening to the Holy Quran may also provide spiritually meaningful support and a sense of calm during painful contractions [32, 33].
Although the two groups were comparable in their sociodemographic and obstetric characteristics, the baseline VAS pain score was higher in the Quran recitation group than in the back massage group. This difference may be related to the non-randomized, time-sequential allocation design. Therefore, the findings should be interpreted with caution. To minimize the influence of baseline differences, multivariate linear regression analysis was performed, adjusting for relevant confounders including gestational age, time of admission, prior Quran exposure, and baseline pain intensity. After adjustment, Quran recitation remained significantly associated with lower post-intervention pain intensity, suggesting a potential independent effect of the intervention.
Limitations
A key strength of this study is that it evaluated a culturally meaningful non-pharmacological intervention during labor using multiple maternal outcomes, providing a comprehensive assessment of the labour experience. It also contributes evidence from an Omani context, where limited research is available. However, the study was limited by its single-site design, small convenience sample, and the possibility of Hawthorne and measurement biases, as participants and assessors were not blinded. Furthermore, only short-term outcomes were assessed. Larger randomized multicentre studies with longer follow-up are therefore needed.
Conclusion
This study suggests that Holy Quran recitation may be a culturally acceptable and supportive non-pharmacological intervention during labor, with potential benefits for pain behaviour, childbirth comfort, and maternal physiological responses. By offering spiritual reassurance and emotional support, it may help women cope more positively with labour. As a simple, low-cost, and non-invasive approach, Quran recitation may be considered as part of individualized maternity care for women who prefer spiritually supportive practices. Nevertheless, the findings should be interpreted with caution due to the quasi-experimental design. Further large-scale randomized multicentre studies are recommended to confirm these associations and guide clinical integration.
Acknowledgements
The authors would like to thank the staff of Khoula Hospital, Oman, and the Ministry of Health for their support and cooperation. Special thanks are extended to the participating mothers and the midwifery team for their valuable contributions to this study.
Abbreviations
- BP
Blood pressure
- CCQ
Childbirth Comfort Questionnaire
- CI
Confidence interval
- CS
Cesarean section
- df
Degrees of freedom
- PBOS
Pain Behavioral Observation Scale
- PTSD
Post-traumatic stress disorder
- RERAC
Research and Ethical Review and Approval Committee
- SD
Standard deviation
- SPSS
Statistical Package for the Social Sciences
- VAS
Visual Analogue Scale
Authors’ contributions
Sophia Cyril VIncent.—Contributed to drafting the project proposal, supervising the research process, interpreting the data, developing the manuscript, critically revising the manuscript, and handling correspondence. Widad N.O. Al -Kharusi- Contributed to submitting the project proposal, obtaining ethical approval, recruiting participants, collecting data, implementing the intervention, and reviewing the manuscript draft. Fatima K.R.Al Muqbali —contributed to participant coordination, clinical support during data collection, implementation of the intervention procedures, and review of the manuscript. Aysha Al Hashmi—contributed to the literature review, manuscript editing, and review of the final version. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability
The datasets generated and analysed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was reviewed and approved by the Research and Ethics Committee of Khoula Hospital, Oman, and the Research and Ethical Review and Approval Committee (RERAC) of the Ministry of Health, Oman (Approval Code: PRO 0092019043B). Informed written consent was obtained from all participants before inclusion in the study. All procedures were performed according to the Helsinki guidelines in accordance with the Declaration of Helsinki
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and analysed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.