Narrative Nursing for Cesarean Mothers' Anxiety and Breastfeeding Confidence (NARRCARE)

Psychological Effects and Breastfeeding Self-Efficacy of a Structured Four-Step Narrative Nursing Intervention in Cesarean Mothers: A Randomized Controlled Mixed-Methods Study

This study tests whether a nurse-led "4-step narrative nursing" program can reduce anxiety and improve breastfeeding confidence in mothers who are having a planned or non-emergency cesarean section.

What is the problem? About 30-40% of Chinese cesarean mothers feel high anxiety after surgery, and 1 in 5 is at risk for postpartum depression. Low confidence in breastfeeding is also common.

What will we do?

We will randomly assign 160 mothers (1:1) to either:

Usual care - standard education and ward care, or

Usual care plus narrative nursing - four short (10-20 min) conversations with a trained nurse:

Before surgery - help the mother talk about her fears. 24-48 h after surgery - encourage her to "name" pain or worries and separate them from herself.

Before discharge - guide her to find positive moments and build a "strong-mom" story.

Two weeks later by phone - strengthen the new story and review feeding success. What will we measure? Main result: anxiety score at 48 h (STAI scale). Other results: depression risk, breastfeeding confidence, pain, and feeding rates up to 3 months.

Possible benefits:

Lower anxiety, better mood, higher breastfeeding rates. No drugs or extra procedures are involved, only talking.

Risks:

Minimal; some mothers may feel emotional during conversations, but nurses can pause or refer to counselling if needed.

Study Overview

• Status: Recruiting
• Conditions: Postpartum Anxiety; Cesarean Section Wound; Postpartum Depression (PPD); Breastfeeding Self-Efficacy
• Intervention / Treatment: Behavioral: 4-step narrative nursing program

• Study Type: Interventional
• Enrollment (Estimated): 160
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: X i Huang; Phone Number: +86-156-8090-6987; Email: 24520241154909@stu.xmu.edu.cn
• Study Contact Backup: Name: Yinchun Tan; Phone Number: +86-152-8329-4749; Email: 2027687568@qq.com

Study Locations

• China
  • Sichuan
    • Nanchong, Sichuan, China, 637600
      • Recruiting
      • Yilong County Maternal and Child Health Hospital
      • Contact: Yinchun Tan; Phone Number: +86-152-8329-4749; Email: 2027687568@qq.com
      • Contact: Xi Huang; Phone Number: +86-156-8090-6987; Email: 24520241154909@stu.xmu.edu.cn
      • Principal Investigator: Xi Huang

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Women aged 18-50 years
2. Scheduled for elective or non-emergency cesarean section at ≥37 weeks
3. Able to communicate in Mandarin and provide written informed consent
4. Expected hospital stay ≥24 h
5. Singleton pregnancy with stable maternal and neonatal condition allowing routine mother-baby contact

Exclusion Criteria:

1. Severe psychiatric disorders (schizophrenia, bipolar disorder, active suicidal ideation)
2. Maternal or neonatal need for ICU/NICU admission
3. Emergency cesarean section preventing baseline assessment
4. Communication or cognitive impairment precluding interview

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Routine perinatal care; Participants receive standard ward education, nursing care, discharge instructions, and routine telephone follow-up without any additional narrative sessions.
Experimental: 4-step narrative nursing; Participants receive usual care plus four nurse-led narrative sessions (pre-op externalization, post-op deconstruction, pre-discharge reconstruction, and 2-week meaning-reconstruction phone call) aimed at reducing anxiety and enhancing breastfeeding confidence.	Behavioral: 4-step narrative nursing program; Four nurse-led storytelling sessions (pre-operative externalization, post-operative deconstruction, pre-discharge reconstruction, and 2-week meaning-reconstruction phone call) aimed at reducing anxiety and increasing breastfeeding self-efficacy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postpartum anxiety at 48 hours	Mean score on the State-Trait Anxiety Inventory (STAI-State, 20 items) assessed 48 hours after cesarean delivery. Lower scores indicate less anxiety.	48 hours post-surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postpartum depression risk	Proportion of women with Edinburgh Postnatal Depression Scale (EPDS) ≥ 10 at 48 hours, 2 weeks and 3 months.	48 hours, 2 weeks, 3 months postpartum
Breastfeeding self-efficacy	Mean score on the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF, 14 items) at 48 hours, 2 weeks and 3 months. Higher scores indicate greater confidence.	48 hours, 2 weeks, 3 months postpartum
Pain intensity	Mean Numerical Rating Scale (NRS, 0-10) for self-reported pain at 48 hours and 2 weeks.	48 hours and 2 weeks postpartum
Breastfeeding continuation rate	Percentage of women who report any breastfeeding at 3 months.	3 months postpartum

Collaborators and Investigators

• Sponsor: Xi Huang
• Collaborators: Xiamen University; Yilong People's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2025
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): March 1, 2026

Study Registration Dates

• First Submitted: November 26, 2025
• First Submitted That Met QC Criteria: December 8, 2025
• First Posted (Estimated): December 9, 2025

Study Record Updates

• Last Update Posted (Actual): December 18, 2025
• Last Update Submitted That Met QC Criteria: December 11, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: China; randomized controlled trial; cesarean section; postpartum anxiety; mixed-methods; storytelling intervention; narrative nursing; breastfeeding confidence
• Additional Relevant MeSH Terms: Urogenital Diseases; Mental Disorders; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications; Mood Disorders; Puerperal Disorders; Depressive Disorder; Depression, Postpartum
• Other Study ID Numbers: XMUNARRCARE2025; FJ2022B061 (Other Grant/Funding Number: Fujian Provincial Social Science Foundation); XMSHLXH2320 (Other Grant/Funding Number: Xiamen Nursing Association); Basic Nursing II (Other Grant/Funding Number: Fujian First-Class Undergraduate Program)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Yes, we plan to share individual participant data (IPD). The de-identified IPD underlying published results will be made available to qualified researchers beginning 9 months after article publication and ending 36 months post-publication. Data access will be granted after approval of a methodologically sound proposal and execution of a data-sharing agreement. Interested parties should contact the corresponding author.

IPD Sharing Time Frame

IPD and supporting information will be made available beginning 9 months after the primary results paper has been accepted for publication and ending 36 months after that date.

An extension may be granted if a justifiable request is received before the closing date.

IPD Sharing Access Criteria

Access is limited to qualified researchers with IRB/REC-approved, methodologically sound proposals relevant to the approved indication.

Only de-identified participant data and the data dictionary will be provided. Requests should be e-mailed to 【corresponding-author@univ.edu】 with a 1-page protocol and statistical analysis plan.

A data-sharing agreement outlining terms of use, confidentiality, and no attempt to re-identify participants must be signed before access is granted.

Data will be shared through a password-protected secure cloud link; download is logged and audited.

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No