To look into the effects of different anesthesia methods on the labor process and the expression of serum estrogen and progesterone in primiparas with painless labor.
60 primiparas receiving painless labor were selected as the research objects, and they were divided into either a Spinal & Continuous epidural anesthesia group (n = 30) or a continuous epidural anesthesia group (n = 30), anesthesia is administered using the corresponding anesthesia method. The authors compared serum estrogen and progesterone, inflammatory index expression, pain degree and neonatal health status in different periods.
At T2 and T3, serum P, LH, FSH and E2 levels in the Spinal & Continuous epidural anesthesia group were signally lower than those in the Spinal & Continuous epidural anesthesia group (p < 0.05). Spinal & Continuous epidural anesthesia group harbored faster onset and longer duration of sensory block and motor block than the Continuous epidural anesthesia group (p < 0.05). SAS and SDS scores of the Spinal & Continuous epidural anesthesia group were clearly lower than those of the Continuous epidural anesthesia group (p < 0.05). VAS score and serum TNF-α, IL-6 levels of pregnant women in the Spinal & Continuous epidural anesthesia group were memorably lower than those in the Continuous epidural anesthesia group at T2 and T3 (p < 0.05). The total incidence of postoperative complications in the Spinal & Continuous epidural anesthesia group was distinctively lower than that in the Continuous epidural anesthesia group (p < 0.05).
Spinal anesthesia combined with continuous epidural anesthesia has a better anesthesia effect in the painless labor of primiparas, which can effectually ameliorate the labor process and the expression of serum estrogen and progesterone.

Background: Induction of labor (IOL) in nulliparas with premature rupture of membranes (PROM) and an unfavorable cervix at term poses challenges. Our study sought to investigate the impact of prostaglandin E2 (PGE2) compared to oxytocin on the duration of IOL in this specific group of parturients. Methods: This was retrospective matched-case study. All nulliparas with term PROM who underwent induction between January 2006 to April 2023 at Shaare Zedek Medical Center were identified. Cases induced by either PGE2 or oxytocin were matched by the following criteria: (1) time from PROM to IOL; (2) modified Bishop score prior to IOL ≤ 5; (3) newborn birthweight; and (4) vertex position. The primary outcome was time from IOL to delivery. Results: Ninety-five matched cases were identified. All had a modified Bishop score ≤ 5. Maternal age (26 ± 4.7 years old, p = 0.203) and gestational age at delivery (38.6 ± 0.6, p = 0.701) were similar between the groups. Matched factors including time from PROM to IOL (23.5 ± 19.2 versus 24.3 ± 21.4 p = 0.780), birth weight of the newborn (3111 g versus 3101 g, p = 0.842), and occiput anterior position (present on 98% in both groups p = 0.687) were similar. Time from IOL to delivery was significantly shorter by 3 h and 36 min in the group induced with oxytocin than in the group induced with PGE2 (p = 0.025). Within 24 h, 55 (58%) of those induced with PGE2 delivered, compared to 72 (76%) of those induced with oxytocin, (p = 0.033). The cesarean delivery rates [18 (19%) versus 17 (18%)], blood transfusion rates [2 (2%) versus 3 (3%)], and Apgar scores (8.8 versus 8.9) were similar between the groups (PGE2 versus oxytocin, respectively), p ≥ 0.387. Conclusions: Induction with oxytocin, among nulliparas with term PROM and an unfavorable cervix, was associated with a shorter time from IOL to delivery and a higher rate of vaginal delivery within 24 h, with no difference in short-term maternal or neonatal adverse outcomes.

BACKGROUND: Childbirth is a long-lasting physiological stress. As one of the main stressors, labor pain exists throughout the whole process. Childbirth self-efficacy is the confidence, or belief that they can manage pain during childbirth. This sense of self-efficacy determines how pregnant women deal with labor pain and enables them to regulate their behavior and actively deal with childbirth. However, the difference in pain sensitivity between single births (primiparas) and multiple births (multiparas) has rarely been investigated.
OBJECTIVE: This study is aimed at investigating self-efficacy, fear of childbirth, labor pain of primiparas and multiparas and exploring factors related to the perceived labor pain intensity of pregnant women.
METHODS: Prospective cross-sectional study.
METHODS: Labour and delivery in a large academic specialized hospital in Guangzhou, China.
METHODS: A total of 347 women, (182 primiparas and 165 multiparas) were enrolled in the data analysis. Pain was assessed before cervical dilatation (cervical dilatation ≤ 3 cm for the first delivery and ≤ 2 cm for the second delivery).
METHODS: The general information of participants was obtained by questionnaire and obstetrical records of the subjects were obtained from the electronic medical records extracted from the electronic medical record system (EMRS). Childbirth self-efficacy, fear of childbirth (FOC) and labor pain were compared between primiparas and multiparas. Paired t-test, chi-square test, Mann-Whitney test, univariate and multivariate regression analysis were used to analyze labor pain between the two groups and investigate factors related perceived labor pain intensity.
RESULTS: The total scores related to fear of childbirth, fetal health, self-control, and labor pain injury of multiparas were notably reduced compared with primiparas (all P < 0.05). The perceived labor pain intensity and duration of the first stage of labor was reduced in the multipara group compared with the primipara group. The childbirth control sense of the multipara was better than that of the primipara. The perceived labor pain intensity was negatively correlated with advanced age (age ≥ 35 years), self-efficacy score, family support, and education (all P < 0.05). In contrast, the perceived labor pain intensity was positively correlated with tension, severe fear of childbirth, and anxiety (P < 0.05). Self-efficacy, gravidity, delivery cognition, and fear of childbirth were independent risk factors for the perceived labor pain intensity in the latent period (all P < 0.05).
CONCLUSIONS: Fear of childbirth is a predictor of perceived labor pain intensity. The extent of labor pain (minimum and maximum) can be predicted by the level of fear the expectant mother has. During the latent phase of labor, self-efficacy, fear of childbirth and labor pain are different between primiparas and multiparas.

Lactation relies on the secretion of two key hormones, prolactin and oxytocin. Studies have shown that yoga in the postpartum period can stimulate feelings of comfort and relaxation, which increases oxytocin production. The aim of this study was to evaluate the effect of yoga training on postpartum prolactin and oxytocin levels in a group of primipara women. This quasi-experimental study included 60 healthy primigravida, primipara women in their third trimester who attended antepartum and postpartum care at four primary healthcare centers in Kediri Regency. The participants were randomly allocated to an intervention group (n = 30) and a control (n = 30) group. The intervention group received health education and participated at eight yoga sessions with a duration of 60 min, from week 32 of gestation until the postpartum period. The control group received standard antepartum and postpartum care. Prolactin and oxytocin levels were measured in weeks 1 and 6 postpartum. Mean prolactin increment was significantly higher in the intervention group (176.8 ± 66.6 ng/ml) than the control group (24.8 ± 39.5 ng/ml). Similarly, mean oxytocin increment was significantly higher in the intervention group (58.6 ± 31.59 pg/ml) than the control group (14.6 ± 36.06 pg/ml). Our results suggest that yoga training in the third trimester until the postpartum period increases prolactin and oxytocin levels among primipara postpartum women.

BACKGROUND: Breastfeeding technique is a combination of positioning, attachment, and breast milk suckling. Breastfeeding problems are caused by incorrect breastfeeding practices, which lead to premature discontinuation of breastfeeding. Therefore, this study aimed to determine the proportion of breastfeeding techniques and associated factors among lactating primiparous mothers during the postpartum period in the Debre Markos town health facility in 2021.
METHODS: An institutional-based cross-sectional study was conducted from November 1st to December 30, 2021. A systematic sampling technique was utilized to select study participants. An observational checklist developed by WHO and an interviewer-administered questionnaire were used to collect data from 409 mothers. The collected data were entered into Epi-Data version 4.6.0.4 statistical software and then exported to SPSS version 24.0 for cleaning and analysis. Binary and multivariable logistic regression was carried out to identify the factors associated with the practice of effective breastfeeding techniques. A variable that has a p-value of ≤0.2 was transferred to a multivariable for further analysis. The strength of association was identified using an adjusted odds ratio with a 95% confidence interval, and a p-value <0.05 was taken as statistically significant.
RESULTS: The proportion of practicing effective breastfeeding techniques among lactating primipara mothers was 29.1% (CI: 24.7, 33.3). Baby aged ≥29 days, mothers who were living in urban, mothers who attended college or higher education, mothers who have heard about BFT practices, mothers who received counseling on BFT after delivery, and mothers whose breast nipples had everted were variables that were significantly associated with the practice of effective breastfeeding techniques.
CONCLUSIONS: The findings of this study revealed that the practice of effective breastfeeding techniques among lactating primipara mothers was lower in the study area. Therefore, healthcare providers should have to counsel mothers on how to position and attach their infants during breastfeeding.
CONCLUSIONS: The provision of breast-feeding method counseling to nursing mothers is one way to enhance the practices of breast feeding.

UNASSIGNED: The timely initiation of complementary feeding is essential to reduce infant mortality. In Ethiopia, 37.5 % of mothers did not initiate complementary feeding to their infants in time. However, previous studies could not identify the time to initiate complementary feeding among primipara mothers. Therefore, this study aims to identify the time to initiate complementary feeding and its predictors among primipara mothers with infants aged 6-12 months in the Awi zone, northwest Ethiopia.
UNASSIGNED: A community-based retrospective follow-up study was conducted among 732 primipara mothers who had infants aged 6-12 months from January 1, 2022, to December 30, 2022. A multistage sampling technique was used to select study participants through questionnaires administered by interviewers. Data were entered into EPI-data 3.1 and exported to STATA 17 for further analysis. The Kaplan-Meier survival curve together with the log-rank test was used to assess the survival experience of the infant at specific times and to compare the survival of the infant in it between different categorical independent variables. Bivariable and multivariable Cox proportional hazard regression models were used to identify significant predictors. Model fitness was also assessed using the Schoenfield residual and the Cox-Snell global residual test. Statistical significance was declared at the p-value <0.05.
UNASSIGNED: The median time to initiate complementary feeding among primipara mother-infant pairs was 6 ± 2 months. The overall incidence rate of complementary feeding initiation before, at and after 6 months of age of the infant was 7.28 (95%CI: 6.44, 8.25), 41.41 (95%CI: 36.05, 47.56), and 42.97 (95%CI: 36.89, 50.05) per 100 person-month observations, respectively. Among those mothers who initiated complementary feeding for their infants, 249, 200, and 165 initiated complementary feeding before, at and after 6 months of age of the infants. Furthermore, the age (15-24 years) of mothers (AHR: 1.63, 95%CI: 1.16, 2.29), rich wealth (AHR: 1.35, 95%CI: 1.05, 1.75), and richest wealth (AHR: 1.43, 95%CI: 1.10, 1.84) were identified as statistically significant predictors of the time to initiate complementary feeding.
UNASSIGNED: The median time to initiate complementary feeding among primipara mother-infant pairs was 6 months. The age of the mother and the wealth status of the household were found to be statistically independent predictors of the time to initiate complementary feeding. Therefore, community health professionals are better able to work on when to initiate complementary feeding to infants of rich and richest young primipara mothers.

UNASSIGNED: In view of the lack of attention and predictability in postpartum breastfeeding in primiparas, health education on breastfeeding during pregnancy should be carried out to publicize the benefits of breastfeeding.
UNASSIGNED: To investigate how well the primiparas during pregnancy are known of breastfeeding knowledge, and to provide a basis for developing health education measures for them.
UNASSIGNED: With the adoption of the objective sampling method and the principle of saturation, 10 primiparas in the obstetrics outpatient department of the Hunan Provincial People\'s Hospital were selected as the study participants. Semi-structured in-depth interviews combined with the observation method were used for data collection. The interview data were analyzed and the theme was refined by Colaizzi\'s seven-step method.
UNASSIGNED: The results of the four themes of the cognition of breastfeeding knowledge among primiparas were as follows: Lack of knowledge and curiosity about breastfeeding in some women, lack of access to correct breastfeeding knowledge, insufficient support from family members for postpartum breastfeeding, and lack of approach to solve problems during breastfeeding among primiparas.
UNASSIGNED: Due to the current problems of the cognition of breastfeeding knowledge in primiparas, it was imperative to build a health education model suitable for primiparas to improve this knowledge.

BACKGROUND: The comprehension and utilization of timing theory and behavior change can offer a more extensive and individualized provision of support and treatment alternatives for primipara. This has the potential to enhance the psychological well-being and overall quality of life for primipara, while also furnishing healthcare providers with efficacious interventions to tackle the psychological and physiological obstacles encountered during the stages of pregnancy and postpartum.
OBJECTIVE: To explore the effect of timing theory combined with behavior change on self-efficacy, negative emotions and quality of life in patients with primipara.
METHODS: A total of 80 primipara cases were selected and admitted to our hospital between August 2020 and May 2022. These cases were divided into two groups, namely the observation group and the control group, with 40 cases in each group. The nursing interventions differed between the two groups, with the control group receiving routine nursing and the observation group receiving integrated nursing based on the timing theory and behavior change. The study aimed to compare the pre- and post-nursing scores of Chinese Perceived Stress Scale (CPSS), Edinburgh Postpartum Depression Scale (EPDS), Self-rating Anxiety Scale (SAS), breast milk knowledge, self-efficacy, and SF-36 quality of life in both groups.
RESULTS: After nursing, the CPSS, EPDS, and SAS scores of the two groups was significantly lower than that before nursing, and the CPSS, EPDS, and SAS scores of the observation group was significantly lower than that of the control group (P = 0.002, P = 0.011, and P = 0.001 respectively). After nursing, the breastfeeding knowledge mastery, self-efficacy, and SF-36 quality of life scores was significantly higher than that before nursing, and the breastfeeding knowledge mastery (P = 0.013), self-efficacy (P = 0.008), and SF-36 quality of life (P = 0.011) scores of the observation group was significantly higher than that of the control group.
CONCLUSIONS: The integration of timing theory and behavior change integrated theory has been found to be an effective approach in alleviating negative mood and stress experienced by primipara individuals, while also enhancing their self-efficacy and overall quality of life. This study focuses on the key concepts of timing theory, behavior change, primipara individuals, negative mood, and quality of life.

A prolonged second stage of vaginal delivery increases the risk of shoulder dystocia, unnecessary episiotomies and cesarean sections. However, no standardized method has been proposed to tackle this issue. The effects of pelvic floor myofascial manipulation intervention during the second stage of labor in primiparas and its prognostic value in neonatal postpartum outcomes remain unknown. In the present study, a total of 60 primiparas who were expecting a vaginal delivery in the Second Affiliated Hospital of Hainan Medical College (Haikou, China) between October 2021 and January 2022 were selected. These women were randomly assigned to a control group (standard intrapartum care) or an experimental group (pelvic floor myofascial manipulation for 15-20 min during the second stage of labor along with standard intrapartum care) using a random number table, with 28 patients in each group. There was no significant difference in age, gestational time or body mass index between the two groups before delivery, indicating that the baseline data were comparable. The second stage of labor duration, forced breath-holding time and postpartum hemorrhage volume in the experimental group were significantly lower than those in the control group. The pain visual analog scale scores, fatigue scores and neonatal Apgar scores in the experimental group were also significantly lower than those in the control group. The rate of episiotomy in the experimental group was lower than that in the control group, but the difference was not statistically significant. In conclusion, pelvic floor myofascial manipulation intervention during the second stage of labor for primiparas with vaginal delivery can reduce the duration of the second stage of labor, the amount of bleeding during labor and the pain during labor. Meanwhile, it has the potential to improve neonatal outcomes.

UNASSIGNED: The goal is to evaluate the effects of a flipped class strategy on knowledge, self-directed learning ability, learning satisfaction and pregnancy outcomes in primiparas undergoing antenatal education.
UNASSIGNED: A random sampling method was adopted. A total of 600 primiparas who were diagnosed with early pregnancy in a first-class hospital in southeast China and received continuous prenatal health education from May to July 2020 were selected as the research subjects. In order to make the baseline of the two groups of primipara comparable, we divided the two groups in the antenatal education centre according to the odd-even number of the lesson card number. The odd-numbered group was the experimental group, who used the prenatal health education model based on blended learning; the even-numbered group was the control group, who used the traditional mode of prenatal health education. The two groups were compared on the following outcomes: knowledge, self-directed learning ability, learning satisfaction and pregnancy outcomes.
UNASSIGNED: Compared with traditional learning, the blended learning approach can effectively controlled the gestational weight gain (GWG), alleviated the anxiety and depression during pregnancy, improved the natural delivery rate of the primipara, shortened the delivery process and reduced the risk of gestational diabetes mellitus (GDM), the difference was statistically significant (all P<0.05).
UNASSIGNED: Blended learning may be an effective strategy because of its validity and practicality in antenatal education.