Labor Scale Research Articles

Emotional Labor as a Mediator between the Relationship of Public Service Motivation and Job Performance of Registered Medical Technologists

The status of level of commitment of registered medical technologists (RMTs) may be expressed in relation to emotional labor, which eventually affected job performance and delivery of laboratory results, more so, during a time of pandemic. A total of 106 Metro Manila-based RMTs participated in this descriptive correlational study that determined if emotional labor (EL) is a mediator between the relationship of public service motivation (PSM) and job performance (JP). The online survey questionnaire included identified Demographic Profile variables, Emotional Labor Scale, revised PSM Scale, and Individual Work Performance Questionnaire. Descriptive statistics, Pearson Product- Moment Correlation and ANOVA were utilized. Results showed that RMTs have average EL in terms of surface acting and high in terms of deep acting, naturally felt emotions, and emotional termination. In terms of PSM, the respondents have an average attraction to policy making and compassion, and have high levels of commitment to public interest, and self-sacrifice. The RMTs have very high JP in terms of task performance and contextual performance, and high counterproductive work behavior. Significant relationships were found among EL, PSM, and JP. However, EL and PSM are not found to be predictors of JP, hence, EL is not a mediator between PSM and JP. The results may serve as a basis for revision of laws or formulation of additional policies beneficial to healthcare workers. Formulation of programs or workshops engaging RMTs on training could reinforce service motivation, emotional stability, and job performance. Results could be a basis for revision of the BSMT curriculum that may include courses on understanding EL, PSM and JP.

Development and Validation of Nurse Emotional Labor Scale (NELS)

Emotionally demanding patient interactions, when coupled with organizational directives to focus on exemplary customer service, can prompt nurses to express feelings and emotions that are not genuine and involves a great deal of emotional labor.

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In this study, two related variables are examined: emotional quotient and emotional labour. Emotional quotient is defined that identifying the emotions, developing empathy, the ability to motive people through emotions and managing the emotions wisely. Population of this study is teachers working at elementary, secondary and high schools in the cities which are located in central Anatolia, Turkey. The sample was chosen from 12 schools and teachers are selected randomly based on the criterion of one school each of the school levels from every school district. The sample schools have totally 417 teachers that 150 of them at elementary, 125 of them at secondary and 142 of them at high school. The data was collected with “Personal Information Form”, “Emotional Labor Scale”, and Emotional Quotient. SPSS 21.00 was used for data analyses including mean, standard deviation, correlation coefficient, and multiple linear regression analysis. Dependent variables of the study are emotional quotient scores of the teachers, independent variable is their emotional labour behaviours. The results of this study reveal that teachers have the highest level in the self-emotion appraisal which is the sub-scale of the emotional behaviour while they have the lowest level in regulation of emotion which is the sub-scale of the emotional quotients. Article visualizations:

Collegial surface acting emotional labour, burnout and intention to leave in novice and pre-retirement nurses in the United Kingdom: A cross-sectional study.

AimTo investigate the relationship between surface and deep acting in nurses' patient‐focused and collegial emotional labour, with emotional exhaustion, depersonalization and personal accomplishment and intention to leave.DesignA cross‐sectional descriptive study using the Emotional Labour Scale, the Maslach Burnout Inventory and intention to leave Yes/No questions with 118 Registered Nurses to measure patient‐focused and collegial emotional labour, burnout and intention to leave.ResultsSurface acting in patient‐focused and collegial emotional labour was found to have positive associations with burnout and intention to leave their current job. Only surface acting in patient‐focused emotional labour was positively associated with intention to leave the organization and/or the profession. The novice nurses carried out more deep acting collegial emotional labour than the pre‐retirement nurses.ConclusionsCollegial emotional labour is significant to nurses' intention to leave their current job but not their intention to leave the organization and/or the profession.

Effects of Intrinsic Motivation on Teacher Emotional Labor: Mediating Role of Affective Commitment

Emotions have an important place in the survival of humankind since its existence. Despite the importance of the emotions in human life and it is not taken on the agenda for a long time in working life. This study aims to examine the impacts of intrinsic motivation on teacher emotional labor with mediating effect of affective commitment. In the study, the relational screening model one of the quantitative research methods was used. The research was carried out 345 teachers who work in ten public schools in Istanbul. As the data collection tools three different scales were used. The intrinsic motivation scale was developed by Lawler and Hall (1970) and adapted to Turkish language by Yilmaz (2008). The emotional commitment scale consists of six items as a sub-dimension of the organizational commitment scale developed by Allen and Mayer (1990). Emotional labor scale, by Diefendorff et al. (2005), it was created, and it was adapted to Turkish in the teacher sample by Basim and Begenirbas (2012). Scale has three dimensions as surface acting, deep acting, and natural behaviors. Results of the study suggest that intrinsic motivation has a negative impact on surface acting and has a positive impact on natural behaviors (genius emotions). On the other hand, affective commitment is not mediated this impact. The findings were discussed, and recommendations were made to the practitioners and researchers.

Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample

BackgroundFear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research.MethodsTen pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale – fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item.ResultsAll measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC.ConclusionsFindings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.

Emotional labor and work engagement at work in military policemen

This study aimed to analyse relations between emotional labor strategies and demands and work engagement in a sample of 302 military policemen. Instruments were the Emotional Labour Scale — ELS, Emotion Work Requirements Scale — EWRS and Utrecht Work Engagement Scale — UWES. Predictive Power of emotional labor dimensions were tested through multiple regression analyses. Demands of expressing negative emotions and demands of intensity and variability did not show statistical significant correlation with engagement. Demands of expressing positive emotions to-ward victims, superiors and other policemen, as well as the deep action strategy were both posi-tive predictors, unlike superficial action strategy was a negative predictor of engagement at work. The study gives contributions to differentiate emotional demands according to interaction target group, deepens the understanding of military policemen emotional work and its relation to work engagement, underlyning the relevance of socioemotional competences development among these profesionals.

Incidência e definição do assédio moral entre trabalhadores do transporte coletivo urbano

O estudo identificou a ocorrência e o conhecimento sobre Assédio Moral no Trabalho (AMT) para trabalhadores do transporte coletivo urbano de uma capital do Brasil. Foi realizado um estudo como misto, com 382 trabalhadores, que responderam um questionário de dados sociodemográficos, a Escala Laboral de Assédio Moral e a questões relacionadas ao conhecimento sobre essa violência. Os resultados demonstraram diferença entre o quantitativo de trabalhadores identificados como alvos de AMT pelos itens da escala (48,69%) e aqueles que se reconhecem como assediados (36,34%). A dimensão “condições de trabalho” foi a mais frequentemente citada na amostra. As definições de AMT relacionaram-se com humilhação, desrespeito e constrangimento. Apesar de terem conformidades conceituais com a literatura, estas categorias demonstraram um conhecimento simplificado, salientando elementos objetivos. Conclui-se que essa violência só poderá ser eficazmente com sua definição clara e distinta de outras formas de sofrimento decorrente do trabalho.

Scale and Drivers of Female Agricultural Labor: Evidence from Pakistan

Agricultural labor is largely informal, particularly for female agricultural labor in developing countries. Despite significant participation in the agricultural labor force in Pakistan, women’s contribution is not properly acknowledged and rewarded. The issue is further aggravated by the dearth of literature on gender–labor relations in cropping and livestock activities. Considering this gap in the literature, the current study was conducted with the specific objective of exploring the labor composition of different agricultural activities in different farm size categories in general and, particularly, female agricultural labor (family and hired labor) participation and its determinants in the rice–wheat cropping system of the Punjab province, Pakistan. The data were collected from 300 households across four districts of the province. Labor participation was calculated on an official farm size classification basis, i.e., small (<12.5 acres), medium (12.6–25 acres) and large (>25 acres) farms. The findings show that female labor is predominantly demanded in the manual harvesting of wheat, rice nursery transplantation and harvesting, and the majority of the livestock-related activities. The regression model results showed that family female labor and hired female labor participation significantly depend on the landholding status of farmers, household size, family type and level of education. The interviews also illustrated that labor relations are rapidly changing—ongoing mechanization threatens conventional female labor activities due to the lack of machinery operation skills among females, caused by informal state policies and cultural barriers. The findings of the study have important policy implications for mainstreaming gender status in agricultural policy and rural development and contribute directly to the Sustainable Development Goals on Gender Equality (SDG#5) and Decent Work and Economic Growth (SDG#8), and indirectly to No Poverty (SDG#1), Zero Hunger (SDG#2), Responsible Consumption and Production (SDG#12) and Climate Action (SDG#13).

Emotional labour and burnout syndrome among nigerian politicians

The The manner in which politicians express their emotions while interacting with the electorates determines how the electorates will perceive the ability of the politicians to fulfilltheir electoral promises if voted into power. This paper aims to investigate the relationship between politicians’ emotional labour and burnout syndrome. The sample consists of 400politicians spread around Four (4) Local Government Areas in Delta State, namely: Aniocha North, Aniocha South, Oshimili North, and Oshimili South Local Government Area of DeltaState, Nigeria, irrespective of their political party affiliations. Emotional Labour Scale developed by Diefendorff, Croyle, and Gosserand (2005), and the Maslach Burnout Inventory developed by Maslach and Jackson (1986) were used to collect data from the respondents. Data analysis was done using descriptive statistics, t-tests, Analysis of Variance (ANOVA) and regression analysis. Results indicate that the politicians exhibit a high level of surface acting in the discharge of their responsibilities. It also revealed that they show the least amount of genuine emotions in their work, while the level of deep acting is moderate.In terms of burnout, politicians experience a very high level of emotional exhaustion, a moderate level of both depersonalization and lack of personal accomplishment. Results of the regression analysis show that the three dimensions of emotional labour (surface acting,deep acting and genuine emotions) are very important predictors of burnout among politicians. Consequently, this present results offer a very crucial and innovative contribution to emotional labour literature and more studies are therefore required in order to expand the scope of this research to ensure a more adequategeneralization.

The Relationship Between Emotional Labor and Organizational Commitment

This research study aiming at revealing the relationship between emotional labor behaviors and organizational commitment perception levels of the instructors working in faculties of education, was designed in the relational screening model. The research was carried out with 365 volunteer instructors selected by proportional cluster sampling method and working in 12 Faculties of Education in ADIM Universities in Turkey. The data of the research was collected by using Organizational Commitment Scale and Emotional Labor Scale. Descriptive and inferential statistical techniques were used in data analysis. As a result of the research, it was revealed that the instructors exhibited surface acting behaviors and affective commitment at the highest level. The instructors emotional labor levels were found to be significantly different according to their educational status and whether they did their job willingly or not; while their organizational commitment levels were found to be significantly different according to their title and whether they did their job willingly or not. It was also found that there were positive, low level and moderate, significant relationships between the instructors’ emotional labor levels and their organizational commitment. It was revealed that the instructors’ genuine acting and deep acting behaviors significantly predicted their affective, normative and overall commitment; while their surface acting, deep acting and genuine acting behaviors significantly predicted their continuance commitment. Various suggestions were made such as increasing emotional labor behavior levels of the instructors and appointing the instructors who are eager to do their job willingly.

A Bayesian Estimation of Child Labour in India

Child labour in India involves the largest number of children in any single country in the world. In 2011, 11.8 million children between the ages of 5 and 17 were main workers (those working more than 6 mo) according to the Indian Census. Our estimate of child labour using a combined-data approach is slightly higher than that: 13.2 million (11.4–15.2 million) for ages 5 to 17. There are various opinions on how best to measure the prevalence of child labour. In this study, we use the International Labour Organization (ILO)‘s methodology to define hazardousness and combine it with the most recent United Nations Children’s Fund (UNICEF)‘s time thresholds for economic work and household chores. The specific aims of this study are to estimate the prevalence of child labour in the age group 5 to 17 and to suggest a combined-data approach using Bayesian inference to improve the accuracy of the child labour estimation. This study combines the National Sample Survey on Employment and Unemployment 2011/12 and the India Human Development Survey 2011/12 and compares the result with the reported figures for the incidence of child labour from the Indian Census. Our unique combined-data approach provides a way to improve accuracy, smooth the variations between ages and provide reliable estimates of the scale of child labour in India.

Lise Öğretmenlerinin Duygusal Emek Davranışları ile İşle Bütünleşmeleri Arasındaki İlişki

The aim of this study is to determine the relationship between emotional labor behaviors and work engagement of high school teachers. The study is in the relational screening model. 251 teachers determined by the appropriate sampling method participated in this study. In the study, "Emotional Labor Scale" and "Business Engagement Scale" were used as data collection tools. According to the findings of the research, it was observed that high school teachers often show deep role-playing behaviors and natural emotions, which are among the emotional labor behaviors, while they rarely show superficial role-playing behaviors. It has been observed that teachers show a high level of emotional engagement behaviors, mostly physical and cognitive engagement behaviors for work engagement. While there was a negative meaningful relationship between the superficial role-playing dimension and the emotional engagement dimension, there was a positive meaningful relationship between the natural emotions dimension and the emotional engagement, physical engagement and cognitive engagement dimensions. This relationship is mostly among the dimensions of emotional engagement and natural emotions. Emotional labor behaviors were seen to be a significant predictor of emotional and cognitive engagement behaviors other than physical engagement behaviors.

Translation and psychometric validation of the Chinese version of the Emotional Labour Scale for nurses.

To translate and psychometrically validate the Emotional Labour Scale (ELS) for nurses in China. Emotional labour is an indispensable component of nursing practice. We currently lack a standard instrument to assess nurses' emotional labour that fits the nursing context in China. Using convenience sampling, 561 nurses were recruited from five tertiary comprehensive hospitals. Internal consistency reliability, test-retest reliability, split-half reliability, face validity, content validity, criterion validity and construct validity were used to evaluate the psychometric attributes of the scale. Exploratory factor analysis verified a three-factor scale structure with a cumulative variance contribution of the factors of 61.281%. The three factors were 'emotional control effort in profession,' 'patient-focused emotional suppression' and 'emotional pretence by norms.' Cronbach's alpha values were 0.881, 0.807 and 0.764, respectively. Confirmatory factor analysis results indicated that the three factors were consistent with the original scale structure. The C-ELS for nurses is a reliable and valid instrument with satisfactory psychometric properties. Future studies should recruit a more representative sample of nurses in China to verify the applicability of the scale. A reliable and quantitative instrument is available for leaders to evaluate clinical nurses' emotional labour and establish effective emotional labour management strategies based on the measurement results.

Labour Worry and Postpartum Discomfort of Primiparous Mothers in Konya, Turkey

Increased levels of worry about childbirth labour may lead to the development of obstetric complications. Therefore, this study was designed to determine the factors that affect the birth worry of primiparae. The population of the study consisted of the primiparous women between May and August 2018 in the Dr Ali Kemal Belviranl? Maternity and Children’s Hospital in the province of Konya, Turkey. A total of 240 primiparous women were selected by means of convenience sampling for this descriptive research. The Postpartum Comfort Questionnaire (PPCQ), the Oxford Worries about Labour Scale (OWLS), and a questionnaire that examines socio-demographic and obstetrical features were used to collect the data. The data were analysed with independent samples, the t-test, the one-way ANOVA, and Pearson’s correlation. The mean age of the women was 27.09 ± 5.04 (min.: 18, max.: 41) years and the mean gestation was 38.8 ± 1.1 weeks. The mean score of labour worry was higher while the mean score of postpartum comfort was lower for those women who had a caesarean delivery (OWLS: t = ?6.47, p = 0.001; PPCQ: t = 4.40, p = 0.001), who had high concerns or fears about labour or delivery (OWLS: t = ?7.05, p = 0.001; PPCQ: t = ?7.04, p = 0.001), who were not emotionally supported by their family during pregnancy (OWLS: t = 13.12, p = 0.001, PPCQ: t = 13.12, p = 0.001), and who had experiences of health problems during delivery (OWLS: t = ?5.01, p = 0.001; PPCQ: t = ?6.06, p = 0.001). It has been found that as the OWLS scores increase, the PPCQ scores also increase reflecting a positive correlation (r = 0.672, p < 0.001) between these variables. This study supports existing literature which states that factors such as health status, aspects of labour and social support affect labour worry and the postpartum comfort level. For this reason, increasing women’s comfort in the postpartum period may be provided by being informed about their physical and psychological health as of the antenatal period, and by giving midwifery care and health education that aim to determine their labour worry level and to eliminate it.

THE YEARS SPENT IN AIRLINE INCREASE THE DEEP ACTING EXPERIENCE OF TURKISH CABIN CREW

The aim of this study is to find out the possible effects of demographic characteristics of cabin crew on their emotional labor experiences. Emotional labor concept has been identified by Hochschild’s notorious research on Delta Airline’s cabin attendants and was published in her book “The Managed Heart: Commercialization of Human Feeling” as the first time in the year 1983. In this study, 36 years after Hochschild’s work, the effects of demographic characteristics on the emotional labor experiences of 265 flight attendants who are working for airline companies in Turkey are investigated. In the literature, there are only a few studies on the effects of demographic factors on emotional labor experiences of cabin crew. So, this study provides an important insight into the subject. The emotional labor scale consists of three dimensions; deep acting, surface acting and genuine emotions. For the emotional labor, a total of 13 questions were answered by participants in 5-point Likert type scale through the Internet. Also, six questions related to demographic characteristics were answered. An Exploratory Factor Analysis (EFA) was performed to verify the item distribution on each factor (i.e. deep acting, surface acting and genuine emotions). And, to analyze the differences between the emotional labor experiences of the groups according to age, gender, position, marital status, total working experience and education, independent samples t-tests and one-way ANOVA tests were applied. Independent samples t-tests were used to compare the differences of two groups such as married-single, male-female, flight attendant-flight attendant supervisor. One way ANOVA tests were used to compare the differences of three or more groups according to age, total working experience and education. Tukey HSD tests were performed after one way ANOVA tests to distinguish the statistically different groups. The results show that there are no statistically significant differences between the expressions of emotional labor, deep acting, surface acting and genuine emotions of groups according to gender, marital status, education and age. Yet, there are statistically significant differences between the emotional labor and surface acting experiences of flight attendants and flight attendant supervisors. Also, a statistically significant difference is found between the deep acting experiences of the cabin crew with 4–7 years of experience and those with 8–22 years of experience.

Burnout and work engagement among psychiatric nurses – are work characteristics important?

Aim of the studyThe aim of the study is determination of the relationship between burnout,work engagement, and the emotional display rules, emotional labour, and demands of interactions.Subject or material and methodsSixty psychiatric nurses completed the Polish version of the Maslach-Burnout Inventory MBI, the Polish version of the UWES, the Emotional Labour Scale, Emotion Work Requirements Scale and the Frequency, Duration and Routineness of Interactions Scale.ResultsIt was found that surface acting is associated with greater emotional exhaustion and higher depersonalization, as well as with lower vigour; the expression of naturally felt emotions is associated with lower feeling of the lack of accomplishments. The higher the requirements of hiding negative emotions and the higher the requirements to display positive emotions, the greater the emotional exhaustion whereas the higher the requirements to display positive emotions, the lower the feeling of lack of accomplishments.The higher the frequency of interactions, the lower the depersonalization and lower emotional exhaustion; the higher the routineness of interactions, the higher the depersonalization and higher the feeling of the lack of accomplishments. The duration of interaction is associated with a greater dedication.DiscussionSurface acting, higher requirements of hiding negative emotions, and routineness of interactions are associated with negative effects. Positive results are associated with the expression of naturally felt emotions, higher frequency and duration of interactions. The demands for the display of positive emotions are related with both positive and negative effects.ConclusionsThe results of the study may be of practical importance while developing programmes supporting health of psychiatric nurses.

Intervention of Balint group on the emotional labor and job burnout of nurses in cardiology

Objective: To explore the effect of Balint group on the emotional labor and job burnout of nurses in cardiology, to provide a reference for improving the mental health of nurses in cardiology. Methods: A total of 78 pediatric nurses were randomly divided into observation group and control group by the random number table, 39 observation group nurses were received general nursing training and the intervention of 8- week Balint group, 39 control group nurses were not received anything intervention. Before and after the intervention of 8 weeks, The Emotional Labor Scale(ELS) and Maslach Burnout Inventory(MBI) were used to evaluate the emotional labor and job burnout of nurses. Results: The age of the nurses in the observation group was(26.3±2.7) years old, with 13 undergraduates and 26 specialists; the age of the nurses in the control group was (25.8±2.1) years old, with 14 undergraduates and 25 specialists. After 8 weeks intervention, the surface action score of ELS of observation group was significantly lower than the control group, the deep action and emotional display requirement scores of ELS of observation group were significantly higher than the control group, the differences were statistically significant (P<0.05). The emotional exhaustion and depersonalization factor scores of MBI of observation group were significantly lower than the control group, the personal accomplishment factor score of MBI of observation group was significantly higher than the control group, the differences were statistically significant (P<0.05). Conclusion: The use of Balint group may have contributed to improving emotional lab and job burnout of nurses in cardiology in a large degree.

Mediating effect of emotional labor between professional values and job burnout among ICU nurses

Objective To explore the mediating effect of emotional labor between professional values and job burnout among ICU nurses, and to provide a reference for reducing ICU nurses' job burnout and motivating their work enthusiasm. Methods From June to July 2017, 276 ICU nurses from 3 comprehensive ClassⅢ Grade A hospitals in Nanchang were selected as the subjects by convenience sampling. The General Information Questionnaire and Nurses' Emotional Labor Scale, Professional Values Scale and Job Burnout Scale were used to investigate. Structural equation model was used to explore the mediating effect of emotional labor between professional values and job burnout. Results A total of 276 questionnaires were issued and 249 valid questionnaires. The average score of the Nurses' Emotional Labor Scale of 249 ICU nurses was (3.55±0.45) , the average score of the Professional Values Scale was (3.63±0.41) , and the dimensions scores of the emotional exhaustion, depersonalization and personal accomplishment of the Job Burnout Scale were (2.77±1.07) , (1.54±1.26) , and (3.78±1.16) . The structural equation fitting indexes were as follows: χ2/df=1.155, GFI=0.976, AGFI=0.942, RMSEA=0.027. Professional values and emotional labor of ICU nurses had direct predictive effect on job burnout. Professional values also used emotional labor as an intermediary variable, which indirectly affected job burnout. Conclusions Nursing managers should pay attention to reducing the job burnout of ICU nurses by improving the level of ICU nurses' professional values and optimizing their emotional labor strategies from the individual factor level. Key words: Intensive Care Unit; Nurse; Emotional labor; Professional values; Job burnout; Mediating effect

Effects of antepartum education on worries about labor and mode of delivery

Aim This study evaluated the effects of antenatal education, which was provided in a pregnancy education class, on pregnant women’s concerns about labor and the mode of delivery. Materials and Methods Primigravid pregnant women (n = 144) were enrolled into the study between May 2017 and November 2018. Pregnant women received standard education on nutrition during pregnancy, exercise, methods of coping with pain, and breastfeeding. The participants completed the “Introductory Information Form” and “Oxford Worries about Labour Scale” to collect data. Results A statistically significant difference was found between the participants’ pain, distress, uncertainty, and interventions in the pre-education, post-education, and postpartum periods and mean total score on the Oxford scale (p<.05). However, education had no significant effect on the mode of delivery (p>.05). Conclusion Education provided during pregnancy significantly decreased women’s worries about labor, but it did not lead to a significant difference in the modes of delivery.