Effects of Midwife-guided biırth Affirmation Cards on Labor Process and Experience ın Primigravidas

Effect of Midwife-Guided Birth Affirmation Cards on Labor Duration, Pain, Fear, Control and Perceived Support in Primigravidas: A Randomized Controlled Study

The aim of this study is to evaluate the effects of midwife-guided birth affirmation cards on labor duration, pain level, fear of childbirth, perceived control, and perceived support in primigravidas. The study seeks to determine whether this non-pharmacological approach used during labor improves the childbirth experience. Accordingly, the research aims to answer the question: "Do midwife-guided birth affirmation cards affect labor duration and the childbirth experience, including pain, fear, perceived control, and perceived support, in primigravidas?"

Study Overview

• Status: Recruiting
• Conditions: Labor Pain; Fear of Childbirth; Duration of Labor; Control (Internet Only); Support
• Intervention / Treatment: Other: Midwife-Guided Birth Affirmation Cards

Detailed Description

This study is designed to investigate the use of birth affirmation cards, implemented under midwife guidance, as a non-pharmacological, low-cost, and feasible approach to support the labor process in primigravid women. Labor is not only a physiological process but also a multidimensional experience involving cognitive, emotional, and behavioral responses. Supporting a woman's sense of safety, enhancing coping capacity, and promoting a positive perception of childbirth are critical for improving the overall quality of the birth experience.

Birth affirmation cards are structured tools consisting of brief, positive, and empowering statements aimed at activating internal resources, strengthening self-efficacy, and fostering a positive cognitive framework toward childbirth. The implementation of these cards under midwife guidance ensures not only the delivery of supportive content but also continuous professional support, encouraging the active participation of the woman throughout labor. Therefore, the intervention is expected to contribute not only to psychological comfort but also to improved coping ability during childbirth.

The study will be conducted using a randomized controlled trial design. Participants allocated to the intervention group will receive midwife-guided birth affirmation card support during labor, while the control group will receive standard institutional care. The intervention content is structured around themes such as adaptation to labor, relaxation, confidence, resilience, trust in the body's ability to give birth, and the promotion of a positive childbirth perception. During implementation, the midwife will provide verbal support using the cards in accordance with the clinical condition of the participant and the stage of labor.

The innovative aspect of this study lies in evaluating birth affirmation cards not merely as individual psychological tools but as a structured, midwife-led supportive care intervention. Although existing literature highlights the importance of fear of childbirth, pain perception, perceived control, and perceived support in shaping the childbirth experience, randomized controlled studies examining the combined effects of affirmation-based interventions on these outcomes remain limited. Therefore, this study is expected to contribute to evidence-based midwifery practices and support the development of woman-centered supportive care strategies in labor.

The findings of this study are anticipated to support the integration of easily applicable, cost-effective, and potentially satisfaction-enhancing supportive care practices into routine maternity care. Additionally, promoting a positive childbirth experience may contribute to improved maternal psychological well-being and enhance the visibility and professional role of midwives in intrapartum care.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Fatma B Dr. Öğretim Üyesi; Phone Number: 7767 +904441251; Email: fatma.bay@karatay.edu.tr
• Study Contact Backup: Name: Esma G EBE; Phone Number: +905530833048; Email: angelesma18@hotmail.com

Study Locations

• Turkey (Türkiye)
  • Mersi̇n
    • Mut, Mersi̇n, Turkey (Türkiye), 33600
      • Recruiting
      • Mut Devlet Hastanesi
      • Contact: ESMA G MIDWIFE, 2/1; Phone Number: +905530833048; Email: angelesma18@hotmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Having a singleton pregnancy between 37-42 weeks of gestation
• Being between 18-40 years of age
• Being a primigravida
• Having a cephalic presentation with vertex position
• Being in the active phase of labor (cervical dilatation ≥4 cm)
• Accepting non-invasive interventions
• Having no mental or physical disability
• Being able to understand and speak Turkish
• Willingness to participate in the study

Exclusion Criteria:

• High-risk pregnancies
• Pregnant women at risk of intrapartum complications (e.g., oligohydramnios, polyhydramnios, intrauterine fetal demise, placenta previa, placental abruption, acute fetal distress, preeclampsia, fetal dystocia, macrosomia, etc.)
• Pregnant women with a history of medical or obstetric complications
• Women who have attended antenatal education classes (pregnancy school)
• Women using epidural analgesia or other pharmacological pain management methods
• Women experiencing communication difficulties
• Women who are unwilling to participate in the study Exclusion Criteria from the Study
• Experiencing dizziness, shortness of breath, or other discomfort,
• Difficult and prolonged labor, instrumental delivery, placental retention, postpartum hemorrhage, need for neonatal intensive care,
• Situations requiring emergency cesarean section during labor,
• The woman will be excluded from the study if she ceases to cooperate during labor.

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
Experimental: Midwife-Guided Birth Affirmation Cards; Intervention Group: Participants will receive midwife-guided birth affirmation card support throughout labor in addition to standard care. The midwife will use structured affirmation cards containing positive, empowering statements tailored to the stage of labor and the participant's clinical condition, providing continuous verbal and emotional support.	Other: Midwife-Guided Birth Affirmation Cards; The intervention consists of the application of structured affirmation (positive statement) cards integrated into standard midwifery care during the active phase of labor. A standardized set of 24 culturally appropriate affirmation cards, developed based on literature and expert opinion, will be used. Each participant in the intervention group will be invited to select or be guided to use a subset of these cards (e.g., 4-6 cards) according to personal preference. During uterine contractions, participants will be encouraged to focus on the selected affirmation statements and repeat them silently or aloud in synchronization with breathing techniques. The midwife will support the process by presenting the cards in a visible area, reading them aloud when needed, and providing verbal encouragement. The intervention will be applied in short cycles (approximately 10-15 minutes) depending on the participant's tolerance and can be repeated throughout the active phase of labor.
No Intervention: Control Group; Participants will receive routine institutional intrapartum care without the use of birth affirmation cards or additional structured supportive intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Labor Duration	The researcher will monitor the duration of labor and interventions through the Birth Care Guide. The Birth Care Guide provides a structured monitoring framework aimed at conducting clinical monitoring systematically, based on evidence, and in a woman-centered manner throughout all stages of labor, from the moment the pregnant woman is admitted to the delivery unit. The guide is based on the World Health Organization's (WHO) positive birth experience and intrapartum care model, and includes the regular recording of clinical parameters related to the progress of labor (cervical dilation, uterine contractions, fetal and maternal monitoring findings), as well as principles of respectful maternal care such as continuous midwifery support, informed consent, effective communication, protection of privacy, supportive care practices, and joint decision-making.	Labor/delivery durations: - Stage 1 active phase (≥4 cm to full dilation), - The duration of Stage 2 (from full dilation to the baby's birth) is given in hours and minutes.
labor pains	The researcher will monitor labor pain using a VAS (Visual Analog Scale). The VAS will be used to measure the pain perceived by the individual. This scale was developed by Price et al. (1983) (Price et al., 1983). In this study, a 10 cm long Visual Analog Scale (VAS) will be used for pain assessment. The left end of the scale will be labeled '0 = no pain', and the right end will be labeled '10 = unbearable pain'.	Pain (VAS, 0-10 cm): - Applied once at 4 cm, 6 cm, 8 cm, - Full dilation is reached, - Stage 2.
Fear of Childbirth	The researcher will monitor fear of childbirth using the W-DEQ A and B version. The scale consists of 33 items. Each item is a 6-point Likert scale with scores from 1 to 6, where 1 means "completely" and 6 means "not at all". The minimum possible score on the scale is 33, while the maximum score is 198. Higher scores indicate a higher level of fear of childbirth experienced by women.	Fear (W-DEQ): - W-DEQ-A is administered during the early active phase (4-5 cm) - W-DEQ-B is administered within 2 hours after birth (when the mother is stable).
Perception of Control and Support During Childbirth	The Perception of Control and Support During Childbirth Scale will be used by the researcher. It is administered to assess women's perceptions of control and support during childbirth in the postpartum period. The Perception of Control and Support During Childbirth Scale consists of 33 items in total, comprising sub-dimensions of internal control, external control, and perceived support. The scale is a five-point Likert-type scale, where 1 means "strongly disagree" and 5 means "strongly agree". The lowest possible score is 33, and the highest is 165. A higher score indicates a higher perception of support and control during childbirth.	Sense of Control and Support (SCS): - Applied during the early active phase (4-5 cm) - within 2 hours after birth (when the mother is stable).

Collaborators and Investigators

• Sponsor: KTO Karatay University

Study record dates

Study Major Dates

• Study Start (Actual): March 27, 2026
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): August 31, 2026

Study Registration Dates

• First Submitted: April 3, 2026
• First Submitted That Met QC Criteria: April 14, 2026
• First Posted (Actual): April 21, 2026

Study Record Updates

• Last Update Posted (Actual): May 19, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: fear of childbirth; labor pain; primigravida; midwifery care; perceived control; Affirmation cards; perceived support; non-pharmacological methods
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Labor Pain
• Other Study ID Numbers: 2026/041E.132258

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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