{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:01:22Z","timestamp":1781157682186,"version":"3.54.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This retrospective observational study evaluated the association between a doula delivery program based on self-efficacy theory combined with stage-focused nursing and delivery outcomes (postpartum hemorrhage, perineal tears, and neonatal Apgar scores), labor duration, and labor pain. Secondary objectives included assessing associations with fear of childbirth, psychological state, resilience, childbirth self-efficacy, self-control, and childbirth experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study analyzed clinical data from 98 parturients who underwent vaginal delivery at the hospital between January 2021 and December 2023. Parturients were divided into a comparison group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f49, received stage-focused nursing only) and a study group (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f49, received a self-efficacy theory-based doula program combined with stage-focused nursing) based on the nursing protocol documented at admission, with non-randomized group allocation. Data on delivery outcomes, labor duration, pain intensity (visual analog scale, VAS), fear of childbirth (CAQ), psychological state (PANAS), psychological resilience (CDRISC-10), childbirth self-efficacy (CBSEI-C32), self-control (LAS), and childbirth experience (CEQ) were extracted from electronic medical records. Statistical analysis employed independent\n                      <jats:italic>t<\/jats:italic>\n                      -tests, chi-squared tests, and repeated-measures analysis of variance (ANOVA) as appropriate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study group had a significantly shorter total labor duration (562.76\u202f\u00b1\u202f34.85 vs. 608.59\u202f\u00b1\u202f41.74\u202fmin,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), lower labor pain score (VAS), higher neonatal Apgar score (9.26\u202f\u00b1\u202f0.13 vs. 8.74\u202f\u00b1\u202f0.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and improved psychological outcomes (CAQ, PANAS, and CDRISC-10).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective study, the self-efficacy theory-based doula program combined with stage-focused nursing was associated with improved delivery outcomes, reduced pain, and enhanced psychological wellbeing. However, due to the observational design and potential selection bias, causal inferences cannot be drawn. These observed associations need to be confirmed through prospective randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1683230","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:47:50Z","timestamp":1781156870000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of a self-efficacy theory-driven doula program combined with stage-focused nursing with delivery outcomes: a retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Hongyan","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fuyang Women and Children\u2019s Hospital","place":["Fuyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fuyang Women and Children\u2019s Hospital","place":["Fuyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"226","DOI":"10.4103\/nah.nah_68_23","article-title":"Effects of natural delivery and cesarean section on the result of first hearing screening of newborns","volume":"26","author":"Fu","year":"2024","journal-title":"Noise Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e00022517","DOI":"10.1590\/0102-311X00022517","article-title":"Cost-effectiveness analysis of spontaneous vaginal delivery and elective cesarean for normal risk pregnant women in the Brazilian unified National Health System","volume":"34","author":"Entringer","year":"2018","journal-title":"Cad Saude Publica"},{"key":"ref3","first-page":"436","article-title":"Appropriate technology for birth","volume":"2","year":"1985","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0224313","DOI":"10.1371\/journal.pone.0224313","article-title":"Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: an overview of systematic reviews","volume":"14","author":"Smith","year":"2019","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1111\/2047-3095.12458","article-title":"Women's fear of childbirth during pregnancy: a concept analysis","volume":"6","author":"Souto","year":"2025","journal-title":"Int J Nurs Knowl"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"464","DOI":"10.33314\/jnhrc.v22i03.4604","article-title":"Fear and experience of childbirth among Primiparous women","volume":"22","author":"Pokhrel","year":"2024","journal-title":"J Nepal Health Res Counc"},{"key":"ref7","year":"2018"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1037\/0033-295X.84.2.191","article-title":"Self-efficacy: toward a unifying theory of behavioral change","volume":"84","author":"Bandura","year":"1977","journal-title":"Psychol Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.jogn.2024.04.004","article-title":"Cluster analysis of fear of childbirth, anxiety, depression, and childbirth self-efficacy","volume":"53","author":"Hildingsson","year":"2024","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1080\/07399332.2019.1672171","article-title":"Effect of childbirth education on the perceptions of childbirth and breastfeeding self-efficacy and the obstetric outcomes of nulliparous women","volume":"41","author":"Citak Bilgin","year":"2020","journal-title":"Health Care Women Int"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.jad.2023.04.020","article-title":"The effectiveness of mindfulness-based interventions on self-efficacy and fear of childbirth in pregnant women: a systematic review and meta-analyses","volume":"333","author":"Abdolalipour","year":"2023","journal-title":"J Affect Disord"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003766.pub3","article-title":"Continuous support for women during childbirth","author":"Hodnett","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e214","DOI":"10.1590\/0102-311X00022517","article-title":"Postpartum doulas: motivations and perceptions of practice","volume":"27","author":"Campbell-Voytal","year":"2011","journal-title":"Midwifery"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.jad.2023.04.020","article-title":"The effectiveness of mindfulness-based interventions on self-efficacy and fear of childbirth: a systematic review and meta-analyses","volume":"333","author":"Abdolalipour","year":"2023","journal-title":"J Affect Disord"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1111\/aas.14051","article-title":"Flouroscopic versus conventional epidural blood patch in obstetrics: a retrospective cohort study","volume":"66","author":"Orbach-Zinger","year":"2022","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1213\/00000539-195301000-00041","article-title":"A proposal for a new method of evaluation of the newborn infant","volume":"32","author":"Apgar","year":"1953","journal-title":"Anesth Analg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/s0140-6736(74)90884-8","article-title":"Measurement of pain","volume":"2","author":"Huskisson","year":"1974","journal-title":"Lancet"},{"key":"ref18","first-page":"177","article-title":"China expert consensus on the application of pain assessment scale (2020 edition)","volume":"16","author":"Wan","year":"2020","journal-title":"Chin J Pain"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"219","DOI":"10.3109\/01674820009085591","article-title":"Self-efficacy for labor and childbirth fears in nulliparous pregnant women","volume":"21","author":"Lowe","year":"2000","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"ref20","first-page":"81","article-title":"Sinicization of the scale of fear of childbirth and its reliability and validity test","volume":"31","author":"Wei","year":"2016","journal-title":"J Nurs Sci"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1037\/0022-3514.54.6.1063","article-title":"Development and validation of brief measures of positive and negative affect: the PANAS scales","volume":"54","author":"Watson","year":"1988","journal-title":"J Pers Soc Psychol"},{"key":"ref22","first-page":"54","article-title":"Applicability of the positive and negative emotion scale in China","volume":"17","author":"Huang","year":"2003","journal-title":"Chin Ment Health J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1002\/jts.20271","article-title":"Psychometric analysis and refinement of the Connor-Davidson resilience scale (CD-RISC): validation of a 10-item measure of resilience","volume":"20","author":"Campbell-Sills","year":"2007","journal-title":"J Trauma Stress"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1111\/j.1440-1819.2010.02130.x","article-title":"Psychometric properties of the 10-item Connor-Davidson resilience scale in Chinese earthquake victims","volume":"64","author":"Wang","year":"2010","journal-title":"Psychiatry Clin Neurosci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/nur.4770160209","article-title":"Maternal confidence for labor: development of the childbirth self-efficacy inventory","volume":"16","author":"Lowe","year":"1993","journal-title":"Res Nurs Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1111\/j.1365-2702.2006.01919.x","article-title":"The Chinese childbirth self-efficacy inventory: the development of a short form","volume":"17","author":"Ip","year":"2008","journal-title":"J Clin Nurs"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1002\/nur.4770100503","article-title":"The labour Agentry scale: psychometric properties of an instrument measuring control during childbirth","volume":"10","author":"Hodnett","year":"1987","journal-title":"Res Nurs Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e293","DOI":"10.1016\/j.midw.2011.02.004","article-title":"Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan","volume":"27","author":"Gau","year":"2011","journal-title":"Midwifery"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/1471-2393-10-81","article-title":"Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument","volume":"10","author":"Dencker","year":"2010","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e0215373","DOI":"10.1371\/journal.pone.0215373","article-title":"Adaptation of the childbirth experience questionnaire (CEQ) in China: a multisite cross-sectional study","volume":"14","author":"Zhu","year":"2019","journal-title":"PLoS One"},{"key":"ref31","first-page":"213","article-title":"Utilization of traditional Chinese medicine analgesic and delivery-aiding patch in doula-assisted deliveries: impact on reducing cesarean section rates","volume":"30","author":"Zhou","year":"2024","journal-title":"Altern Ther Health Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2805","DOI":"10.1080\/01443615.2022.2109412","article-title":"Factors relating to childbirth self efficacy among pregnant women: a CHAID analysis","volume":"42","author":"Bostan","year":"2022","journal-title":"J Obstet Gynaecol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"614","DOI":"10.23736\/S2724-5691.21.09191-7","article-title":"Evaluation of the effect of midwife doula accompany nursing on nursing effect and pregnancy outcome of parturient in painless delivery","volume":"77","author":"Zhang","year":"2022","journal-title":"Minerva Surg"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1177\/1054773820916984","article-title":"Effects of antenatal education on fear of birth, depression, anxiety, childbirth self-efficacy, and mode of delivery in Primiparous pregnant women: a prospective randomized controlled study","volume":"30","author":"\u00c7ankaya","year":"2021","journal-title":"Clin Nurs Res"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1186\/s12884-024-06571-3","article-title":"A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: a cross-sectional study","volume":"24","author":"Huang","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1186\/s12884-022-05069-0","article-title":"Doula support among Brazilian women who attended the senses of birth health education intervention - a cross sectional analysis","volume":"22","author":"Fernandes","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1097\/OGX.0000000000001103","article-title":"Doula care: a review of outcomes and impact on birth experience","volume":"78","author":"Ramey-Collier","year":"2023","journal-title":"Obstet Gynecol Surv"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e39451","DOI":"10.7759\/cureus.39451","article-title":"The effect of doulas on maternal and birth outcomes: a scoping review","volume":"15","author":"Sobczak","year":"2023","journal-title":"Cureus"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.12669\/pjms.39.6.7451","article-title":"Effects of a doula instrument combined with auricular acupuncture and acupoint application on numerical rating scale scores, labour time of puerperae with a natural delivery and Apgar scores of the newborns","volume":"39","author":"Sun","year":"2023","journal-title":"Pak J Med Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e70051","DOI":"10.1002\/hsr2.70051","article-title":"The effects of Iranian traditional music on cervical dilation and labor progress in the active stage of term pregnancy: a nonrandomized controlled trial","volume":"7","author":"Jahromi","year":"2024","journal-title":"Health Sci Rep"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s00404-023-07195-2","article-title":"The effects of warm perineal compress on perineal trauma and postpartum pain: a systematic review with meta-analysis and trial sequential analysis","volume":"309","author":"Maghalian","year":"2024","journal-title":"Arch Gynecol Obstet"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"101547","DOI":"10.1016\/j.ajogmf.2024.101547","article-title":"Does combining warm perineal compresses with perineal massage during the second stage of labor reduce perineal trauma? A randomized controlled trial","volume":"7","author":"Shqara","year":"2025","journal-title":"Am J Obstet Gynecol MFM"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1683230\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:47:51Z","timestamp":1781156871000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1683230\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":42,"alternative-id":["10.3389\/fmed.2026.1683230"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1683230","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"article-number":"1683230"}}