Childbirth is an important and unique event for mothers and families. During labour, women may experience fear and anxiety as a result of a range of factors, including previous caesarean section or instrumental birth, lack of support or knowledge about childbirth, decisional conflict, fear of the unknown and low childbirth self-efficacy (Yehia et al, 2013; Isbir and Serçeku§, 2017; Moghaddam Hosseini et al, 2018; Saeedi Aval Nooghabi et al, 2019; Cankaya and Can, 2021). Maternal fear is associated with increased perceptions of pain, longer duration and increased use of synthetic oxytocin in labour, as well as higher rates of operative vaginal birth and negative birth experiences (Rondung et al, 2019; Ilska et al, 2021; O'Connell et al, 2021).
For pregnancy and birth, all women have the right to respectful care, privacy and choice, and to be treated with dignity and be informed according to the latest evidence (World Health Organization (WHO), 2018; Cankaya and Can, 2021). Supportive intrapartum care incorporates the psychosocial aspects of care provided by maternity healthcare professionals to decrease fear, anxiety, discomfort and/or exhaustion for a woman in labour, and confirms that her needs and wishes are known, respected and met (Abdel Azeem and Mohamad, 2019). Dimensions of supportive intrapartum care include physical support and comfort, emotional support, evidence-based informational and instructional support and advocacy (Royal College of Midwives, 2012; isbir and Serçeku?, 2017; WHO, 2018; Cankaya and Can, 2021).
A systematic review of 27 randomised controlled trials from 17 different countries concluded that women who received one-to-one, continuous intrapartum support were more likely to have a spontaneous vaginal birth and shorter labour (Bohren et al, 2017). These women were also less likely to use intrapartum analgesia, have a baby with a low 5-minute Apgar score or report negative feelings about the birth (Bohren et al, 2017). Previous studies about continuous intrapartum support have reported similar outcomes (Nystedt and Hildingsson, 2018; Shorey et al, 2018; Abdel Azeem and Mohamad, 2019; Cankaya and Can, 2021). Supportive intrapartum care enhances women's self-confidence, sense of strength and physical capabilities during labour and birth (Bohren et al, 2017; Isbir and Serçekuç, 2017; Abdel Azeem and Mohamad, 2019; Cankaya and Can, 2021). In Middle Eastern countries, only one quasi-experimental study has been carried out to investigate the effect of intrapartum support on birth outcomes among women (n=100). It was conducted in Egypt and revealed that women in labour in the ‘supportive’ group were less likely to use oxytocin augmentation, reported lower levels of pain and had babies with higher Apgar scores at the first and fifth minute, compared with women receiving routine care (Abdel Azeem and Mohamad, 2019).
The high level of unwarranted medical interventions, negative childbirth experiences and increasing reports of maternal dissatisfaction with intrapartum care have contributed to the inclusion of supportive intrapartum care as a core component of policies in some developing countries (Akuamoah-Boateng and Spencer, 2018; Oladapo et al, 2018; WHO, 2018; United Nations Population Fund, 2021). Supportive intrapartum care prioritises women's ability to participate in discussions and make informed choices (Akuamoah-Boateng and Spencer, 2018).
Intrapartum care in Jordan
In the past 20 years, improved maternal and newborn services in Jordan have contributed to reduced mortality for mothers (29.8 per 100 000 women) and babies (9.5 per 1000 live births) (Ministry of Health, 2021). However, the rates in Jordan are still higher than reported in other Arab countries, although lower than most countries in Africa (WHO, 2020).
Childbirth takes place predominantly in hospitals, mostly performed by resident doctors or obstetricians, and is highly medicalised (Alzyoud et al, 2018; Khresheh et al, 2019). Induction and augmentation of labour, episiotomy, continuous electronic fetal monitoring and use of the lithotomy position for birth are common (Alzyoud et al, 2018; Khresheh et al, 2019). A midwife's role during childbirth is to assist obstetricians and undertake procedures such as episiotomies, vaginal examinations, measuring vital signs, monitoring fetal heart rate and giving medications prescribed by doctors (Mohammad et al, 2020).
Continuity of midwifery care for individual women is uncommon in Jordan and midwives are required to attend to many labouring women simultaneously, making it difficult to provide quality care (Khresheh et al, 2019; Mohammad et al, 2020). The dominance of the medical model in maternity care reduces midwives’ autonomy in decision making. There is also an absence of reliable antenatal education and psychological support, as well as a lack of choice, intimacy and security during labour (Mohammad et al, 2014; Alzyoud et al, 2018; Khresheh et al, 2019). One study reported that 32.2% ofJordanian women experienced neglect (also known as obstetric violence) during childbirth, 37.7% were verbally abused by staff and most did not receive any information about their rights (Alzyoud et al, 2018).
In a qualitative study with 21 Jordanian women, Khresheh et al (2019) reported that fear of childbirth, loss of control, lack of knowledge, feeling disrespected and inadequate communication with staff contributed to negative birth experiences. Lack of tangible caring and emotional support by staff also contributed to dissatisfaction (Khresheh et al, 2019). In a cross-sectional study with 320 Jordanian women, Mohammad et al (2014) reported that more than two-thirds of participants were dissatisfied with intrapartum care, predominantly because of a lack of support from healthcare professionals, overuse of obstetric interventions, disrespectful treatment, lack of involvement in decision making and ineffective communication. Supportive intrapartum care is not applied routinely (Mohammad et al, 2014). Family members are not permitted in birthing rooms in government hospitals and continuous support from staff is not available (Khresheh et al, 2019).
There is a lack of studies investigating the effect of supportive intrapartum care on fear, pain and control during birth among women in Arab countries, including Jordan. This study will provide preliminary data, in preparation for a larger trial in future.
Methods
A quasi-experimental study was conducted, using a pre-, post-test design with a control group. This design was chosen to manage a range of feasibility issues; for example, group assignment was performed according to the participant's choice or by randomisation, and depended on the availability of a participating midwife, as not all midwives volunteered to learn about supportive intrapartum care.
The study was conducted at Jordan University Hospital in Amman Governorate, the capital of Jordan. The hospital has a 599-bed capacity and a birth centre with seven obstetricians, 35 resident doctors, 16 registered midwives, 21 registered nurses and four practical nurses. There are nine individual birthing rooms, three operating theatres, 68 inpatient postpartum beds, a nursery with 48 beds, a 30-bed neonatal intensive care unit and an obstetrics and gynaecology emergency department. The hospital has approximately 4000 births per year. In 2019, there were 1992 normal vaginal births, 1891 caesarean births and 20 forceps/vacuum births.
Sample
Convenience sampling was used to select participants for the study. The inclusion criteria selected for all birthing women who attended the hospital and:
- were aged 18—45 years
- were primi- or multigravida
- had a normal pregnancy (free from chronic conditions or pregnancy-related complications)
- expected a singleton term fetus (37—41 weeks)
- had vertex presentation
- expected a vaginal birth
- were in the first stage of labour (cervical dilation <3cm).
Women who had previously had labour induced, or had epidural analgesia and/or caesarean section were excluded. Women who were enrolled but experienced labour complications or an emergency caesarean birth were excluded, as they could not receive the full supportive care intervention from a midwife.
To calculate sample size, a power of 0.8, medium effect size and significance of 0.05 were used in the Cohen (1992) formula, resulting in a sample of 128 participants. Oversampling was undertaken to account for attrition.
Intervention
Participants were recruited by a member of the research team (a registered female nurse) during a routine antenatal care appointment, when they were in their third trimester. When they subsequently presented to the hospital while in labour, the research team was notified. Participating women were assigned to either the intervention or control group, according to their personal preference (n=108) or the flip of a coin for those who had no preference (n=36). Women were aware of their group allocation. If a participating midwife was not available, then the woman was allocated to the control group.
Midwives were recruited to carry out the intervention following a talk about the study provided by the research team. Six midwives (out of 16) expressed a willingness to join the study. All midwives had a Bachelor of Midwifery and more than 12 months’ experience. Participating midwives completed 2 days of skills training about supportive care practices, as recommended by the Royal College of Midwives (2012) and the WHO (2018). In addition, participating midwives completed a 3-hour session about the research procedures. The content of the training programme is outlined in Table 1. During implementation of the intervention, a member of the research team was present in the clinical environment and acted as a mentor when participating midwives provided care. The mentor gave feedback and encouragement to midwives.
Table 1. Training content
| Type of care | Content |
|---|---|
| Physical care | Ensuring comfortable environment, touch, dim/subdued lighting, privacy, encouraging movement and frequent position changes |
| Emotional support | Constant midwife presence, effective communication between woman and midwife, listening to women, positive caring attitude |
| Evidence-based information and instructional support | Providing information about labour and progress, coaching about breathing, relaxation and pushing techniques |
| Advocacy support | Assisting women in decision making and resolution of conflict, protecting woman from harm, ensuring privacy and confidentiality |
The intervention began upon hospital admission and finished at the end of the third stage of labour. The intervention was not standardised, because labour differs for every woman and each woman responded differently to various relaxation methods. During labour, supportive care interventions were offered in accordance with the participants’ preferences. Continuous supportive care was provided during labour and birth, as recommended by the Royal College of Midwives (2012) and WHO (2018). Routine care and analgesia (pethidine: 100mg intramuscular injection, 4-hourly) was also offered based on severity of pain (according to the hospital's policy). Participants in the control group received routine care.
Data collection
Two researchers, blinded to the participants’ group allocation, collected the data. The study was conducted from August 2019 to January 2020.
Instruments
A sociodemographic data form was administered upon enrolment in the study (during routine antenatal care when the participant was in their third trimester). The form asked for the participant's age, education, occupation, total monthly household income, gravidity, parity and gestation at commencement of labour.
The Wijma delivery expectancy questionnaire-B was used to measure fear of childbirth (Wijma et al, 2002). The questionnaire includes both positively and negatively worded items (n=10). Participants responded to each item on a scale ranging from 1 (completely agree) to 10 (completely disagree). Negatively worded items were reverse scored. The total score ranged from 10—100, with higher scores indicating greater fear. The questionnaire is a widely used, reliable, self-administered tool that has been validated in numerous countries (Wijma et al, 2002; Isbir and Serçekuç, 2017). The Cronbach's alpha reliability coefficient for internal consistency was 0.88 (Wijma et al, 2002). Women were asked to complete this questionnaire by a research assistant both when admitted to the birthing room (T1) and within 24 hours postpartum, in the postnatal ward before discharge (T2).
A visual analogue scale was used to assess the participants’ perceptions of pain. This numeric scale is displayed on a 10cm line ranging from 0 (no pain at all) to 10 (extreme pain) (Couper et al, 2006). All participants were assessed for labour pain during the latent, active and transition phases of first stage labour by a researcher blinded to women's group allocation.
The perceived support and control in birth scale (Ford et al, 2009) consists of 33 items distributed on three subscales to assess internal control (10 items), external control (11 items), and support (12 items). Responses are rated on a 5-point Likert response scale ranging from 1 (completely disagree) to 5 (completely agree). Scores range from 33—165, with higher scores indicating greater perceived control and support during childbirth. The scale has good Cronbach's alphas ranging from 0.81 to 0.95 (Ford et al, 2009; Liu et al, 2020). It is self-reported and was administered by a researcher within 24 hours postpartum before discharge.
Before the study, the instruments were pilot tested with a group of 20 Jordanian women. The time required to complete the instruments was 15—20 minutes. The items were reported to be easily understood and did not need any changes. These women were not included in the main study. The internal reliability was assessed, revealing a good Cronbach's alpha for the fear scale (0.85) and control total scale (0.88) and subscales (internal control=0.92; external control=0.87 and perceived support=0.91).
Translation
Approval to use and translate the instruments was obtained from the relevant authors (Wijma et al, 2002; Ford et al, 2009). All instruments were translated into Arabic and back-translated by two professional translators. Content validity was assessed using the content validity index, evaluated by three experts in obstetrics and gynaecology (one in nursing and two in midwifery). Each item was rated on a scale of four options: 1=no relevance, 2=somewhat relevant, 3=has relevance but needs to be changed slightly, 4=has relevance (Polit and Beck, 2011). The index was determined based on the proportion of items that were scored as relevant (3 or 4). The resulting index was 1, indicating that all items were clear, relevant, comprehensive and easy to administer.
Data analysis
Data were entered and analysed by two researchers using the Statistical Package for Social Science (version 22). Collected data were cleaned and reviewed for completeness and consistency within a single data form and among data forms. Data were checked for normality. Descriptive statistics (frequency, percentage, mean and standard deviation) were used to describe participants’ characteristics. T-tests were used to compare the mean differences between the intervention and control groups. Multiple regression analysis was performed for the whole cohort to identify factors associated with fear of childbirth. Preliminary analyses were carried out to check for violations of normality and for multicollinearity before fitting the multiple regression model. Statistical significance was determined at P<0.05.
Ethical considerations
Ethical approval was obtained from the institutional review board of the Jordan University of Science and Technology and Jordan University Hospital (reference: 238/2019). All participants received an information sheet explaining the aims and details of the study, and gave written consent to participate.
Results
During the study, 154 women were approached to participate. Of these, 10 declined, eight were excluded for an emergency caesarean section, and two withdrew after birth. The final sample included 134 women who were allocated to the intervention (n=65) or control group (n=69) (Figure 1).
Table 2 outlines the participants’ sociodemographic characteristics. The mean age was 29.75 years (±6.02 years). Nearly a third of participants (30.6%) were 26—30 years old, 50.7% had completed a Bachelor's degree, 64.2% were housewives and 44.0% had a total income of <400 Jordanian dollars/month. More than half of the participants had had three or more previous pregnancies (55.2%), and 44.8% had had more than three children. Only 26.9% of women were primiparous.
Table 2. Participants’ demographic characteristics
| Variable | Frequency (%) | ||||
|---|---|---|---|---|---|
| Total, n=134 | Control, n=69 | Intervention, n=65 | |||
| Age (years) | ≤25 | 35 (26.1) | 19 (27.5) | 16 (24.6) | |
| 26-30 | 41 (30.6) | 21 (30.4) | 20 (30.8) | ||
| 31-34 | 32 (23.9) | 14 (20.3) | 14 (21.5) | ||
| ≥35 | 26 (19.4) | 15 (21.8) | 15 (23.1) | ||
| Education | Up to secondary school or less | 43 (32.1) | 21 (30.4) | 17 (26.2) | |
| Diploma | 23 (17.2) | 11 (15.9) | 12 (18.5) | ||
| Bachelor's or higher | 68 (50.7) | 37 (53.7) | 36 (55.3) | ||
| Occupation | Unemployed | 86 (64.2) | 44 (63.8) | 39 (60) | |
| Employed | 48 (35.8) | 25 (36.2) | 26 (40) | ||
| Total monthly income (Jordanian dollars) | <400 | 59 (44.0) | 17 (24.6) | 18 (27.7) | |
| 400-700 | 56 (41.8) | 42 (60.9) | 38 ( 58.5) | ||
| >700 | 19 (14.2) | 10 (14.5) | 9 (13.8) | ||
| Gravidity | 1 | 30 (22.4) | 14 (20.3) | 16 (24.6) | |
| 2 | 30 (22.4) | 16 (23.2) | 12 (18.5) | ||
| ≥3 | 74 (55.2) | 39 (56.5) | 37 (56.9) | ||
| Parity | 1 | 36 (26.9) | 21 (30.4) | 19 (29.2) | |
| 2 | 38 (28.3) | 15 (21.8) | 15 (23.1) | ||
| ≥3 | 60 (44.8) | 33 (47.8) | 31 (47.7) | ||
| Duration of labour (hours) | <10 | 84 (62.7) | 24 (34.8) | 41 (63.1) | |
| 10-20 | 34 (25.4) | 31 (44.9) | 22 (33.8) | ||
| >20 | 16 (11.9) | 14 (20.3) | 2 (3.1) | ||
Table 3 shows differences between groups in terms of levels of fear, pain, perceived control and support during childbirth and duration of labour. Mothers in the intervention group had significantly lower fear scores (t=8.66, P<0.001), and less pain during the latent (t=4.15, P<0.001), active (t=4.64, P<0.001) and transition (t=2.34, P<0.05) phases of labour. They also had higher mean scores of perceived control (t=12.46, P<0.001) and support (t=10.54, P<0.001) during childbirth, and shorter labours (t=10.367, P<0.001) compared to those in the control group. However, there was no significant difference between groups in the levels of perceived external control during childbirth.
Table 3. Effect of supportive care
| Variable | Mean (standard deviation Control | Intervention | t | 95%confidence Interval | P value |
|---|---|---|---|---|---|
| Fear of childbirth (T2) | 57.01 (6.07) | 63.45 (8.60) | 5.00 | -1.98-1.77 | <0.001 |
| Fear of childbirth (T3) | 54.33 (12.55) | 34.12 (14.4) | 8.66 | -5.54-0.25 | <0.001 |
| Pain (latent phase) | 4.08 (1.51) | 3.13 (1.07) | 4.15 | -1.37–0.48 | <0.001 |
| Pain (active phase) | 6.85 (1.26) | 5.85 (1.23) | 4.64 | -1.43–0.48 | <0.001 |
| Pain (transition phase) | 9.52 (0.70) | 9.19 (0.91) | 2.34 | 0.61-0.05 | 0.021 |
| Control in birth | 60.88 (6.61) | 71.55 (5.28) | 12.46 | 14.84-19/25 | <0.001 |
| Internal control | 24.64 (2.98) | 34.16 (3.86) | 15.98 | 8.34-10.30 | <0.001 |
| External control | 33.09 (4.04) | 34.12 (3.4) | 1.60 | 0.25-2.31 | 0.113 |
| Support in birth | 37.37 (3.30) | 43.16 (3.05) | 10.54 | 7.32-9.99 | <0.001 |
| Duration of labour | 14.48(5.20) | 6.91(2.97) | 10.37 | -9.01–6.12 | <0.001 |
The total variance explained by the multi regression model was 34.8% (F(5 133)=13.57, P<0.001). Low control made the strongest unique contribution to fear (β=-0.35) followed by high levels of pain (β=0.20), while low support during childbirth made a small contribution (β=-0.19).
Women who reported low control during birth scored on average 0.82 points higher on the fear scale. Labouring women who reported high pain had scores that were on average 2.44 points higher than women who reported low scores. Labouring women who reported low support during childbirth scored on average 0.75 points higher than those who reported high support. The final analysis is presented in Table 4.
Table 4. Multiple regression analysis predicting fear of childbirth
| Variable | Unstandardised coefficients B | Standard error | Beta | 95 % confidenceInterval | P value |
|---|---|---|---|---|---|
| (Constant) | 119.93 | 15.04 | - | 90.18-149.69 | |
| Control score | -0.82 | 0.20 | -0.35 | -1.22-0.42 | <0.001 |
| Support score | -0.75 | 0.35 | -0.19 | -1.44-0.06 | <0.001 |
| Pain score | 2.44 | 0.94 | 0.20 | 0.58-4.29 | <0.001 |
Discussion
This study is one of the first to examine the effect of supportive intrapartum care on fear, pain and control during childbirth among Jordanian mothers. Women who received supportive intrapartum care (emotional, physical, informational and advocacy support) reported lower perceptions of fear and pain, and higher control and support during childbirth.
Providing support to women during labour and birth can improve perceptions of fear during childbirth. Recommendations by the WHO (2018) aim to increase the availability of supportive intrapartum care to labouring women, to improve their childbirth experience and protect them and their neonates from short- and long-term negative consequences. Despite increasing evidence of its value, supportive intrapartum care is still not practiced in Jordan (Alzyoud et al, 2018; Khresheh et al, 2019). This may be the result of shortages of qualified midwives (Abuidhail et al, 2021) in addition to high birth rates (176 557 births annually) (Department of Statistics, 2021). The ratio of midwives to women in labour in Jordan is one to 20 (Mohammad et al, 2022). To manage the large number of women giving birth, midwives use active management of first stage labour, following obstetricians’ orders to decrease the time for each woman to give birth (Abuidhail et al, 2021). Inadequate staffing is hazardous to safe midwifery practice and threatens maternal and newborn wellbeing (Mohammad et al, 2022).
The influence of supportive intrapartum care on fear of childbirth found in the present study is consistent with previous studies in middle-income countries (Isbir and Serçekuç, 2017; Cankaya and Can, 2021). Women left alone during labour or who do not receive adequate care and support from healthcare providers, in particular midwives, may be more prone to fear during childbirth (Nilsson et al, 2010; Isbir and Serçekuç, 2017; Cankaya and Can, 2021). In addition, fear of childbirth among Jordanian women may stem from the lack of antenatal classes that focus on childbirth preparation (Hatamleh et al, 2023). Antenatal education in Jordan is usually provided during one-on-one consultations with women (Hatamleh et al, 2019). Childbirth education can enhance mothers’ ability to cope, assist informed decision making during childbirth, and reduce levels of anxiety and fear (Hatamleh et al, 2023).
The provision of continuous support in the present study may have minimised feelings of loneliness and provided reassurance to the participants. In line with previous studies, the use of relaxation techniques by midwives during labour, when the severity, frequency and duration of contractions increase, may have contributed to the participants’ positive attitudes toward coping (Bohren et al, 2017; Maputle, 2018; Thies-Lagergren and Johansson, 2018; Abdel Azeem and Mohamady, 2019).
Previous studies have suggested that increased perceptions of intrapartum support provided by midwives lead to decreased fear of childbirth (Isbir and Serçekuç, 2017; Cankaya and Can, 2021). Fear of childbirth is influenced by women's feelings of control during labour (Isbir and Serçekuç, 2017; Cankaya and Can, 2021). The present study showed that supportive intrapartum care enhanced perceived internal and external control during childbirth. Control included making decisions, coping with pain, receiving required information and remaining calm (Stevens et al, 2012; Isbir and Serçekuç, 2017; Cankaya and Can, 2021).
Participants in the intervention group reported significantly lower pain scores during labour. The significant relationship between physical support (such as ambulation, changing position and attention to hygiene) and decreased pain is congruent with previous studies (Bohren et al, 2017; Isbir and Serçekuç, 2017; Maputle, 2018; Thies-Lagergren and Johansson, 2018; Abdel Azeem and Mohamad, 2019; Cankaya and Can, 2021). Bala et al (2017) demonstrated that providing massage therapy for at least 30 minutes in a circular motion along the mother's back and the bottom of the feet had a significant effect on decreasing labour pain.
Increased perceptions of support and control in labour were related to supportive intrapartum care. The respect shown to women by participating midwives, the level of information offered, in addition to the use of pharmacological and non-pharmacological methods, may have contributed to women feeling in control and able to manage their pain.
Participants in the intervention group reported significantly shorter labours. This is consistent with previous studies, which reported that supportive intrapartum care significantly decreased the duration of labour (Isbir and Serçekuç, 2017). Supporting a mother to move, lie on her side or sit up during the first stage of labour prevents vena cava compression, assists in the relaxation of the pelvic muscles, improves the descent of the fetus through the pelvis and helps in effacement and dilatation of the cervix, which can shorten labour (Bala et al, 2017).
Strengths and limitations
A strength of this study was the use of the fear and control scales, which are widely validated and facilitate comparisons across studies in different countries. However, this quasi-experimental study had several limitations. There was the potential for bias, because group allocation was based in part on the availability of the participating midwife. Participating midwives may have been more committed to improving their practice, learning new approaches and providing quality care.
The participating organisation enabled midwives to provide one-on-one continuous care to women in the intervention group through increased staffing levels and roster changes, but the sustainability of this model has not been negotiated beyond the study period. Without the support of hospital administrators, continuation of the supportive care model and replication of the model in other settings will not be possible.
The fidelity of the intervention may have varied according to the needs of each woman, and as midwives became more proficient with practice and mentorship. In addition, the use of a relatively small sample limits generalisability; the results can only be generalised to uncomplicated term singleton pregnancies in low-risk mothers experiencing spontaneous vaginal births. Further research is required with more diverse populations.
Repeating the present study in the same context with broader inclusion criteria and random allocation would further establish the effectiveness of supportive intrapartum care in this country. More research is also needed, with a larger sample size, to generalise the results. It is essential to undertake a study exploring midwives’ experiences of providing supportive care during labour. and on the effect of supportive intrapartum care on rates of emergency caesarean section.
Implications for practice
The present study provides valuable information on the benefits of supportive intrapartum care on fear of childbirth in a low resource setting, where continuous support models are not routinely offered. The findings can be used to support practice change and guide the creation of a practice guideline for supportive intrapartum care and a woman-centred care model in Jordanian hospitals. A related training programme would be needed to provide evidence-based information to maternity healthcare providers and develop their skills and confidence in providing supportive intrapartum care. The on-site mentoring offered by the research team to participating midwives as they implemented supportive intrapartum care was beneficial. Awareness of the benefits of supportive intrapartum care practices for mothers will enable obstetricians and midwives to review and change their intrapartum practices. Obtaining research results from the local context, the inclusion of more staff in the study and the provision of education and training may contribute to improving the quality of care and enable health services in Jordan to comply with international guidelines.
Conclusions
The present study showed the significant positive effect of supportive intrapartum care, in terms of physical, emotional, informational and advocacy support, in decreasing fear and pain and enhancing maternal perceptions of support and control during childbirth. This local evidence can be used to promote education and mentoring of midwives and their practice in Jordanian hospitals.
Key points
- Supportive intrapartum care decreased women's perceptions of pain and fear and improved perceptions of control and support.
- The training programme providing evidence-based information to midwives developed their skills and confidence in providing supportive intrapartum care.
- Policies directed at the routine implementation of supportive intrapartum care are essential to decrease women's perceptions of pain and fear of childbirth.