Background: While multimodal non-opioid analgesia may help reduce opioid-related side effects, opioid use can still lead to dose-dependent tolerance, dependence, and addiction in some patients, impacting maternal satisfaction. This limitation has sparked interest in opioid-free multimodal analgesia, which combines non-opioid and adjuvant analgesics on a scheduled basis, reserving opioids for rescue analgesia only. Magnesium sulfate, an adjuvant analgesic, is a suitable component of opioid-free analgesia, particularly for preeclamptic women on magnesium sulfate undergoing caesarean section, as it may contribute to improved maternal satisfaction and outcomes. Aim: To determine and compare maternal satisfaction in opioid-free analgesia treated preeclamptic women and opioid-based analgesia treated preeclamptic women undergoing caesarean section. Methods: Ethical approval was obtained from the research ethics committee of Federal Medical Centre, Yenagoa. The study was a superiority randomized clinical trial. One hundred preeclamptic women undergoing caesarean section who gave consent and met the eligibility criteria was enrolled into the study. Sampling method was convenience sampling. Randomization was carried out by using WINPEPI. There were two groups with 50 participants in group A (experimental arm) and 50 participants in group B (control arm). Experimental arm received postoperative intravenous paracetamol, intramuscular placebo and rectal diclofenac for 24 hours. Control arm received postoperative intramuscular pentazocine, intravenous paracetamol and rectal diclofenac for 24 hours. Rescue analgesia (intramuscular pethidine) was administered to women in this study outside the established analgesic regimen for both arms of the study if needed. A Likert scale was used to assess maternal satisfaction 24 hours post-surgery. Statistical significance was pValue <0.05. Results: Patients in the treatment arm B reported less severe pain (0% vs. 38%), greater satisfaction with pain relief (68% vs. 28%), and a higher likelihood of recommending the treatment (68% vs. 44%). Fewer patients in the treatment arm B rated their satisfaction as poor or very poor (12% vs. 34%), and more rated it as excellent (34% vs. 0%). However, dissatisfaction with pain relief methods was prevalent in both groups (92% vs. 98%). Statistical significance was observed in pain experience (0% vs. 38%), satisfaction (28% vs. 68%), and perceived effectiveness (0% vs. 34%). Conclusion: While opioid-based multimodal analgesia provided significantly better pain relief and higher maternal satisfaction, opioid-free multimodal analgesia remained a viable and acceptable alternative for postoperative pain management in preeclamptic women receiving magnesium sulphate after caesarean section.

Background The rising incidence of complications linked to labor analgesia underscores the need for targeted strategies to improve maternal outcomes. Staged nursing, a tiered approach to assessment and care, has been proposed to enhance safety and reduce adverse events during labor. Objective This study aimed to evaluate whether staged nursing care is more effective than standard nursing in reducing the complications associated with labor analgesia. Materials and methods This retrospective cohort study included 278 women who received either standard nursing care or staged nursing care during labor between January 2018 and December 2021 at a tertiary care hospital. Staged nursing involved structured assessments, continuous monitoring, and individualized interventions. The primary outcomes were the incidence of analgesia-related complications. Secondary outcomes included labor duration, analgesia dosage, and maternal satisfaction. Results The staged nursing group showed significantly lower rates of hypotension (8.6% vs. 18.0%, p = 0.03), respiratory depression (2.2% vs. 7.9%, p = 0.04), inadequate pain control (6.5% vs. 16.5%, p = 0.01), and post-dural puncture headache (2.9% vs. 10.1%, p = 0.02) than the control group. Satisfaction scores were higher in the intervention group (4.3 vs. 3.5, p < 0.001), and both labor duration and analgesia dosage were significantly reduced. Conclusion Staged nursing effectively reduces complications and improves maternal satisfaction during labor. These findings suggest that structured nursing protocols can enhance maternal safety and should be considered for integration into routine obstetric care.

Maternal satisfaction is a key measure of the quality of healthcare services and a determinant of maternal and neonatal health outcomes. This study examined the availability and women’s satisfaction with maternal health services in Tertiary Health Institutions in Anambra State, Nigeria. A cross-sectional study design was employed, involving 167 women aged 18-49 years attending healthcare services at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH). Data were collected using self-structured questionnaires and analyzed using descriptive and inferential statistics, with significance set at the 0.05 level. Results show that awareness of maternal health services was high (91.02%), with antenatal care the most utilized service (93.41%), followed by delivery (75.45%), postnatal (74.25%), and family planning services (29.52%). Satisfaction levels were highest for antenatal care (96.4%) and family planning services (85.5%), compared to delivery (78.9%) and postnatal services (74.1%). In conclusion, although satisfaction with maternal healthcare services was generally high, gaps in the availability of delivery and family planning services highlight the need for improved infrastructure, enhanced provider training, and greater access to family planning education. Addressing these issues is critical to improving maternal and neonatal health outcomes in Tertiary Health Institutions in Nigeria.

to estimate the combined prevalence of maternal satisfaction with breastfeeding and associated factors. a systematic prevalence review, according to the PRISMA and JBI protocols. Searches were conducted in PubMed/MEDLINE, LILACS, Scopus, Embase, Web of Science, and CINAHL, using the "Breastfeeding" and "Personal Satisfaction" descriptors. Data were extracted, tabulated, and presented in a meta-synthesis, applying meta-analysis to quantitative data. twelve studies published between 2003 and 2024 were included. The results indicated moderate maternal satisfaction with breastfeeding. Higher scores were observed in conditions favorable to breastfeeding and when breastfeeding was longer, and lower scores were observed in cases of early weaning, unmet expectations and intentions regarding breastfeeding, as well as complications in the process. Professional support contributed to satisfaction. factors that influence satisfaction with breastfeeding were revealed. However, the subjectivity of the concept and the multiplicity of measurement instruments may have contributed to the studies' high heterogeneity.

Effect of a mobility-encouragement protocol during induction of labor with an extraamniotic balloon compared with routine care: a randomized controlled trial.

Happy mothers, healthy minds: Maternal welfare and children's early development in the global south.

AimsThe aim of this study was to evaluate the impact of free-position delivery combined with perineal massage on nursing-sensitive quality indicators and clinical outcomes in high-risk pregnant women.MethodsThis retrospective cohort study analyzed clinical data from 223 high-risk pregnant women who underwent vaginal delivery between January 2023 and December 2024. Participants were allocated to either the Traditional Supine Delivery group (TSD, n = 117) or the Free-Position and Perineal Massage group (FPPM, n = 106) based on delivery mode. Baseline characteristics, durations of labor, perineal injuries, postpartum hemorrhage, anesthesia requirements, postpartum complications, neonatal conditions, psychological status, and maternal satisfaction were compared.ResultsCompared with TSD, the FPPM group had shorter active first stage and second stage of labor (5.98 ± 1.25 vs. 6.33 ± 1.21 h; 82.01 ± 8.14 vs. 85.48 ± 7.85 min; both p < 0.05), and a lower rate of perineal lacerations (59.43% vs. 76.07%; p = 0.008), episiotomy (16.04% vs. 27.35%; p = 0.042), and postpartum hemorrhage ≥500 mL (5.66% vs. 13.68%; p = 0.045). FPPM also reduced intrapartum anesthesia requirements and postpartum complications while improved 5-min Apgar scores (9.80 ± 0.35 vs. 9.69 ± 0.42; p = 0.036), maternal satisfaction (69.81% vs. 52.14% very satisfied; p = 0.026), and PTSD symptoms (28.44 ± 2.31 vs. 29.52 ± 2.86; p = 0.002).ConclusionFree-position delivery combined with perineal massage in high-risk pregnant women is associated with better nursing-sensitive quality indicators, lower rates of perineal trauma and postpartum complications, improved neonatal outcomes, and higher maternal satisfaction compared with traditional supine delivery.

The transversus abdominis plane (TAP) block is widely used to enhance postoperative analgesia after cesarean sections (CS). This study aimed to compare the effect of combining the transversalis fascia plane (TFP) block with the TAP block versus intrathecal morphine (ITM) on postoperative recovery quality assessed using the Obstetric Quality of Recovery-10 (ObsQoR-10T) score. This prospective, randomized clinical trial was conducted at a single university hospital. One hundred patients undergoing elective CS under spinal anesthesia were randomized into two groups. Group ITM received spinal anesthesia comprising 10mg 0.5% hyperbaric bupivacaine, 15µg fentanyl, and 100µg morphine. Group TAP + TFP received spinal anesthesia with 10mg of 0.5% hyperbaric bupivacaine and 15µg of fentanyl, without intrathecal morphine. In the TAP + TFP group only, bilateral TAP and TFP blocks were performed at the end of surgery, whereas no block was administered in the ITM group. Postoperative analgesia was provided using fentanyl-based patient-controlled analgesia (PCA). The primary outcome was the ObsQoR-10T score which was assessed at 24h postoperatively. Secondary outcomes included opioid consumption, pain scores at rest and movement, adverse effects, and patient satisfaction. There was no significant difference between the groups regarding the total ObsQoR-10T scores (91.72 ± 6.46 vs. 91.56 ± 5.54, p = 0.895). The TAP + TFP group had significantly higher fentanyl consumption at 24h compared to the ITM group (187.50µg vs. 87.50µg, p = 0.005). No significant differences were found in pain scores at rest or during movement. The incidence of adverse effects and patient satisfaction rates were comparable between groups. The TAP + TFP block combination yielded a similar overall ObsQoR-10T recovery profile to ITM. Both strategies provided satisfactory analgesia and high maternal satisfaction. ClinicalTrials.gov ID: NCT06944912 retrospectively registered at clinicaltrials, principal investigator: Ali Ahiskalioglu (registration date: April 18, 2025).

The erector spinae plane block (ESPB) has emerged as a novel regional anesthesia technique for managing pain during labor, providing an effective alternative to traditional methods. The present investigation evaluates efficacy and safety as well as maternal satisfaction in labor pain management. A comprehensive analysis of patients receiving ESPB was conducted, comparing outcomes to those receiving standard analgesia, such as epidural anesthesia. Results show that the ESPB provided significant pain relief during labor, with comparable or superior efficacy to traditional methods. Patients reported high levels of satisfaction due to the minimally invasive nature of the procedure and its favorable side effect profile, including reduced motor blockade and improved mobility during labor. The ESPB was also associated with a lower risk of complications, such as hypotension, commonly observed with epidural techniques. Furthermore, the technique's simplicity and versatility make it an attractive option for obstetric anesthesia providers, particularly in settings where epidural placement may be contraindicated or those with limited resources. This study explores the importance of exploring alternative pain management strategies that prioritize maternal comfort, safety, and overall labor experience. By reducing pain effectively while maintaining maternal mobilityand minimizing adverse effects, the ESPB offers a patient-centered approachto labor analgesia. Future research should focus on optimizing regimens andlong-term outcomes for both mothers and neonates. The findings supportESPB as a valuable addition to the arsenal of pain management optionsduring labor.

Background: Maternal satisfaction serves as an essential indicator of the quality of delivery care, particularly in resource-constrained settings. Midwives, as central providers of respectful maternity care, deeply influence women’s childbirth experiences. Despite Bangladesh’s policy shift toward midwife-led care, evidence on mothers’ satisfaction with such services at the primary healthcare level remains limited. Methods: A descriptive cross-sectional study was conducted from July 2023 to June 2024 in four Upazila Health Complexes of Bogura (Gabtali, Sariakandi, Shahjahanpur, and Shibgonj). Using convenience sampling, 299 postpartum mothers aged 18–49 who received midwife-led delivery care were interviewed with a semi-structured questionnaire including the validated SMMS-Normal Birth scale (43 items, 5-point Likert). A cut-off score of 150.5 distinguished greater from lesser satisfaction. Data were analyzed using SPSS version 26. Results: Overall, 72.3% of mothers reported greater satisfaction (mean score 162.49 ± 18.88). Satisfaction was higher among rural mothers (77.3%), low-income households (≤BDT 20,000: 53.2%), and those in kacha/semi-pacca houses (39.1%) (p &lt; 0.05). It was also associated with primiparity (42.1%), wanted pregnancies (85.6%), planned deliveries (74.9%), antenatal care (73.6%), prenatal counseling (59.5%), shorter labor (19.7%), intact perineum (43.1%), postpartum guidance (78.9%), and involvement in decision-making (55.9%) (p &lt; 0.05). Multivariate analysis showed multiparity (AOR: 6.79), pacca housing (AOR: 2.79), low income (AOR: 3.27), absence of prenatal counseling (AOR: 8.54), perineal trauma (AOR: 7.49), lack of postpartum care (AOR: 2.43), and non-involvement in decision-making (AOR: 3.51) as independent predictors of lesser satisfaction. Conclusion: Most mothers reported greater satisfaction with midwife-led delivery services at UHCs. Addressing gaps in counseling, postpartum care, and participatory decision-making can further improve maternal experiences and outcome.

Introduction: Labor pain is considered one of the most intense experiences in a woman’s reproductive life and is influenced by physiological, emotional, and cultural factors. In recent decades, the increasing medicalization of childbirth has expanded the use of pharmacological analgesia, although non-pharmacological methods have been recommended as safe, accessible, and woman-centered strategies. Objective: To synthesize scientific evidence on the effectiveness of non-pharmacological methods for pain relief during labor. Method: Observational and descriptive literature review based on clinical studies, systematic reviews, meta-analyses, and technical guidelines identified in PubMed, SciELO, and CAPES databases, using descriptors related to non-pharmacological pain management in labor. Results: Evidence shows that interventions such as hydrotherapy, massage, upright positions, breathing techniques, music therapy, acupressure, and continuous support significantly reduce pain scores, promote physiological progression of labor, and increase maternal satisfaction. Multimodal protocols demonstrated greater effectiveness compared to isolated methods, with reduced need for pharmacological analgesia and fewer obstetric interventions. Conclusion: Non-pharmacological methods are effective and humanized approaches for labor pain relief. Their systematic adoption can improve maternal experience and promote safer childbirth, underscoring the need for broader implementation in health services and professional training for their appropriate use.

Background: Cesarean section remains a major contributor to maternal and neonatal complications, with repeat cesarean sections being a primary factor. Vaginal birth after cesarean (VBAC) offers a potential alternative, and its success and maternal satisfaction depend on structured, multicomponent interventions. Objectives: The present study aimed to determine the effect of a multicomponent prenatal intervention on maternal satisfaction following VBAC. Methods: A randomized controlled trial was conducted at Amin Hospital, Isfahan, Iran (March 2024 - March 2025). Eligible women with one prior cesarean and a gestational age &lt; 24 weeks were randomly assigned to repeat cesarean section (control, n = 50) or VBAC (intervention, n = 50) groups via permuted block randomization. The intervention included eight individual/group counseling sessions, at least eight prenatal visits, one acupressure session, and delivery at a specialized center. Data were collected via a demographic questionnaire and the Birth Satisfaction Scale (BSS). The data were analyzed via descriptive statistics (means, standard deviations, frequencies, and percentages) and inferential statistics (independent t-tests and chi-square tests). Results: The VBAC success was achieved in 52% of the intervention group (26/50), with no VBACs in the control group (P &lt; 0.001). Overall maternal satisfaction scores did not differ significantly between groups (control: 157.68 ± 20.45 vs. intervention: 163.15 ± 22.45), but significant improvements were noted in postpartum care (P = 0.003) and participation in childbirth (P = 0.018). Conclusions: Although overall maternal satisfaction did not differ significantly between groups, the multicomponent VBAC-focused intervention increased VBAC success and increased satisfaction with specific aspects of care.

Effect of antenatal education and midwifery-led care on maternal anxiety, depression, and birth outcomes: A meta-analysis of clinical trials.

Abstract Background Attention Deficit Hyperactivity Disorder is a common neurodevelopmental disorder that can lead to familial stress, whereas autism spectrum disorder results in significant social and communication impairments. Mothers of children with these neurodevelopmental disorders report heightened anxiety, depression, and decreased self-esteem, impacting marital satisfaction. Objectives The study aimed to assess and compare marital satisfaction and coping patterns among mothers of children with ADHD, ASD, and a control group of mothers with typically developing children. Subjects and methods Conducted at the Al Abassia psychiatric hospital, this cross-sectional comparative study involved 78 mothers divided into three groups: 26 each with children diagnosed with ADHD, ASD, and healthy controls. Various scales were employed to evaluate intelligence and symptom severity among children, together with marital satisfaction and coping styles among mothers. Results The mothers of children with ASD scored notably the least marital satisfaction among the 3 groups, especially affectional expression and resort to maladaptive coping strategies compared to the other 2 groups. Logistic regression revealed that poor planning strategies negatively affected marital satisfaction among mothers of children with ADHD, while for those with ASD, the Children’s Autism Rating Scale scores were pivotal. Conclusion The findings highlight the necessity for programs aimed at fostering both child development and parental well-being, highlighting maternal coping mechanisms and marital satisfaction. Further research is needed to dive deeper into these issues.

Induction of labour using cervical double-balloon (Cook catheter) in outpatient versus inpatient setting (COOK study): a multicentre, open-label, randomised controlled trial.

This study evaluated the effects of a Structured Alternative Program (SAP) on pain management and maternal satisfaction during childbirth. SAP involved non-pharmacological techniques aimed at reducing labour pain and enhancing the birth experience. A total of 127 primiparous mothers were randomly assigned to either an experimental group (SAP) or a control group (epidural). Findings showed that the experimental group experienced shorter durations in the first and second stages of labour and reported higher satisfaction. A negative correlation was found between labour duration and satisfaction. SAP offers a natural approach to pain relief, improving maternal confidence and overall childbirth experience.

Episiotomy remains a common obstetric procedure, and the choice of suture material can influence postoperative pain, wound healing, and maternal satisfaction. Objectives: To compare Monocryl and Vicryl Rapide for mediolateral episiotomy repair in terms of pain, wound healing, complications, and patient satisfaction. Methods: A quasi-experimental study was conducted at the Gynecology Department, KRL General Hospital, Islamabad, from August 2022 to October 2023. Sixty women (18–45 years) undergoing spontaneous vaginal delivery were randomized into two groups (n = 30 each). Skin closure was done with Monocryl 3-0 (study group) or Vicryl Rapide 3-0 (control group), while deeper layers were closed with Vicryl Rapide 0 in both groups. Pain was assessed using the Visual Analog Scale (VAS). Results: Baseline demographics were comparable between groups (p&gt;0.05). The study group reported significantly lower pain at 1 hour (p=0.001), 3 hours (1.53 ± 1.41 vs. 3.30 ± 2.38, p=0.001), 6 hours (0.97 ± 1.59 vs. 2.63 ± 2.01, p=0.001), after defecation (0.63 ± 0.93 vs. 2.00 ± 1.46, p&lt;0.001), after urination (0.53 ± 0.82 vs. 1.63 ± 1.35, p&lt;0.001), and on day 7 (p&lt;0.001). Wound healing was significantly better with Monocryl (p=0.005), and patient satisfaction was higher (p=0.001). No infections occurred in the Monocryl group, compared to 6.7% in the control. Conclusions: Monocryl demonstrated clear superiority over Vicryl Rapide for episiotomy repair, offering reduced pain, improved wound healing, and higher maternal satisfaction.

Introduction: Epidural analgesia is the gold standard for pain management during labor due to its efficacy and safety. Patient-controlled epidural analgesia (PCEA) allows self-administration of analgesic boluses, improving maternal satisfaction and optimizing neonatal outcomes. In recent years, the concept of “respectful childbirth” has promoted techniques that enhance maternal mobility and active participation. Walking epidural analgesia (WEA), which uses lower concentrations of local anesthetics, enables ambulation during labor while maintaining effective pain relief. Objective: To evaluate the impact of walking epidural analgesia (WEA) compared to conventional epidural analgesia (CEA) on obstetric and neonatal outcomes. Methods: A prospective, randomized, observational study was conducted at Clínica Universitaria Reina Fabiola (CURF). Term pregnant women (&gt; 37 weeks, singleton, cephalic presentation) requesting epidural analgesia were randomly assigned to two groups. Group A (WEA): Ropivacaine 0.1% + fentanyl 1 mcg/ml. Group B (CEA): Ropivacaine 0.2% + fentanyl 1 mcg/ml. Primary outcomes included maternal pain control (Numerical Verbal Scale), motor block (Bromage Scale), ambulation ability, mode of delivery, and neonatal Apgar scores. Secondary outcomes assessed maternal satisfaction and potential adverse effects. Results: No significant differences were found in baseline patient characteristics. Both groups achieved adequate pain control, although pain reduction was more pronounced in the CEA group at 20 minutes (p = 0.019). WEA had a low incidence of assisted vaginal delivery without motor block. Ambulation was significantly better in the AEA group (91% unassisted). Most pregnancies resulted in vaginal delivery in both groups. No differences were observed in obstetric outcomes or neonatal wellbeing. Maternal satisfaction was high in both groups. Conclusion: Walking epidural analgesia is an effective and safe alternative to conventional epidural analgesia, aligning with modern obstetric practices that prioritize maternal autonomy and mobility. Proper implementation requires trained personnel to optimize pain control without compromising the benefits of ambulation.

Dural puncture epidural (DPE) is a newer and more advantageous method in labor analgesia. It provides a faster analgesia onset and higher-quality block compared to the conventional epidural (CE) method, while causing fewer adverse effects than the combined spinal-epidural (CSE) technique. This study aims to compare the effects of bupivacaine at different concentrations, but equal volumes administered via DPE on the mother, fetus, and labor process, and reduce total bupivacaine requirement and its potential side effects. Seventy ASA II primigravid pregnant women with cervical dilatation between 4 and 6cm were included in the study. Participants were randomly divided into two groups. Group 1 received a high concentration of bupivacaine (0.125%) + 2 mcg/mL fentanyl; Group 2 received a low concentration of bupivacaine (0.0625%) + 2 mcg/mL fentanyl, both using DPE. The numeric rating scale (NRS) score was aimed to be < 4. The total amount of bupivacaine and fentanyl administered through the epidural catheter, the time between applications, the time between applications and birth, the number of doses administered, complications, maternal vital signs, fetal heart rate and maternal satisfaction were recorded. The mean amount of bupivacaine administered was 31.7 ± 7.6mg in Group 1 and 15.1 ± 3.4mg in Group 2, showing a significant difference (P = 0.001, Mean ± SD, Student's t test). There were no significant differences in NRS scores, duration between doses, duration between doses and delivery, satisfaction, and complications. This study compared the effects of different bupivacaine concentrations with DPE and found that using low-concentration bupivacaine (0.0625%) for labor provides adequate analgesia without increasing complications or delivery time while reducing the amount of bupivacaine needed. Registration number: NCT05499234.Registration date: 2022-08-02 (Retrospectively registered).Registration URL: https://clinicaltrials.gov/ct2/show/NCT05499234 .

This study aims to explore the relationship between pain perception and maternal coping during childbirth through an in-depth qualitative literature review. The primary objective is to synthesize contemporary research findings to understand how physiological, and social factors interact in shaping women’s childbirth experiences. Using a qualitative descriptive approach, data were collected through a systematic review of scholarly books, peer-reviewed journal articles, and official reports published between 2015 and 2025. The analysis involved several stages—data identification, reduction, thematic categorization, and inductive interpretation—to uncover recurring concepts and relationships across the literature. The findings reveal that maternal self-efficacy, emotional support, and non-pharmacological interventions such as breathing exercises, massage, and music therapy significantly reduce perceived pain and enhance coping abilities. Conversely, fear and lack of confidence amplify pain perception and emotional distress. The study highlights the biopsychosocial nature of childbirth, aligning with theoretical frameworks such as Lazarus and Folkman’s stress-coping model and Olza’s neuro-psycho-social model of labor. The results underscore the importance of holistic, woman-centered maternity care that integrates emotional, social, and physical dimensions of childbirth. The research contributes theoretically by expanding understanding of pain-coping interactions and practically by recommending integrative care models that promote maternal empowerment and satisfaction. Future studies are encouraged to employ longitudinal and cross-cultural approaches to deepen insights into the evolving dynamics of coping during labor and postpartum adaptation.