Effect of labor-delivery-recovery-postpartum family-centered obstetrics care combined with painless delivery on postpartum depression in primiparas

Abstract

BACKGROUND

Postpartum depression (PPD) is a prevalent perinatal mood disorder, marked by persistent low mood, anhedonia, and impaired maternal-infant bonding within six weeks postpartum. PPD impairs maternal quality of life, leads to long-term harms, and poses a notable public health burden.

AIM

To investigate the effect of labor-delivery-recovery-postpartum (LDRP) family-centered obstetrics care combined with painless delivery on PPD in primiparas.

METHODS

This retrospective cohort study enrolled 523 primiparas (singleton, term, cephalic, spontaneous labor) from January 2023 to April 2025. The participants were divided into a control group (n = 266, conventional care) and an observation group (n = 257, LDRP + painless delivery). Labor progression, comfort [General Comfort Questionnaire (GCQ) and pain Visual Analog Scale (VAS)], mental health [Childbirth Attitude Questionnaire (CAQ), Pregnancy-Related Anxiety Scale (PAQ), and Edinburgh Postnatal Depression Scale (EPDS)], maternal-neonatal outcomes, and nursing satisfaction were compared between the two groups. Logistic regression was used to identify the risk factors for PPD.

RESULTS

Baseline characteristics were comparable between the two groups (all P > 0.05). The observation group exhibited shorter first/second stages of labor (P < 0.001), higher GCQ scores (all dimensions, P < 0.001), lower VAS scores (P < 0.001), and lower CAQ, PAQ, and EPDS scores (P < 0.001). The incidence of PPD (16.34% vs 33.46%) and severe PPD (4.67% vs 13.91%) were significantly lower in the observation group (P < 0.001). No significant differences were observed in maternal-neonatal safety outcomes (P > 0.05). Nursing satisfaction was higher in the observation group (95.72% vs 70.30%, P < 0.001). Logistic regression analysis identified gestational complications, lack of family accompaniment, nursing dissatisfaction, absence of painless delivery, and no-use of LDRP as independent risk factors for PPD (P < 0.05).

CONCLUSION

LDRP family-centered care combined with painless delivery reduces PPD by shortening labor and improving comfort and nursing satisfaction, supporting its clinical adoption. Clinically, this integrated care model may help improve the childbirth experience and reduce the risk of PPD in primiparas. Future multicenter prospective studies with longer follow-up are needed to further validate these findings and assess their long-term impact on maternal mental health.

Key Words: Labor-delivery-recovery-postpartum family-centered obstetrics care; Painless delivery; Primiparas; Postpartum depression; Labor outcome

Core Tip: This study explores the impact of the labor-delivery-recovery-postpartum (LDRP) family-centered obstetrics care combined with painless delivery on postpartum depression (PPD) in primiparas. The results indicate that the observation group (LDRP + painless delivery) experienced significantly shorter labor, higher comfort levels, and lower rates of PPD compared to the conventional care group. Additionally, gestational complications, lack of family support, and nursing dissatisfaction were identified as independent risk factors for PPD. These findings suggest that LDRP family-centered care and painless delivery can significantly reduce PPD while ensuring maternal and neonatal safety.

INTRODUCTION

Postpartum depression (PPD) is a common perinatal mood disorder, characterized by persistent low mood, anhedonia, and impaired maternal-infant bonding within the first six weeks postpartum. It affects primiparas disproportionately, with global incidence rates ranging from 10% to 20%[1,2]. PPD not only diminishes maternal quality of life but also contributes to long-term adverse outcomes, including impaired infant neurodevelopment and disrupted breastfeeding, posing a significant public health burden[3,4]. Numerous factors have been identified as contributors to PPD, including intrapartum pain, maternal psychological distress, and inadequate social support, all of which are modifiable risk factors[5].

The labor-delivery-recovery-postpartum (LDRP) family-centered obstetrics model integrates antenatal, intrapartum, and postnatal care in a home-like environment. It reduces psychosocial stressors by promoting continuous family support and individualized care[6]. In contrast to traditional fragmented care settings, LDRP enhances maternal security through consistent caregiver-patient relationships and privacy protection, potentially alleviating prenatal anxiety and fear of childbirth. Concurrently, neuraxial labor analgesia, the gold standard for painless delivery, alleviates nociceptive input during labor through epidural administration of low-concentration ropivacaine combined with fentanyl analogs, thus reducing the physiological stress response mediated by the hypothalamic-pituitary-adrenal axis[7].

LDRP care has been associated with increased maternal satisfaction, reduced anxiety, and improved overall childbirth experience[8]. Painless delivery has been shown to optimize perinatal outcomes by effectively relieving labor pain[9]. However, the combined effects of LDRP family-centered care and painless delivery on PPD remain insufficiently studied, particularly in primiparas, who are vulnerable due to limited childbirth experience and heightened role-transition stress. While previous studies have demonstrated the individual roles of LDRP family-centered care in shortening labor duration and neuraxial analgesia in reducing acute pain, their cumulative impact on maternal emotional regulation and PPD incidence is still underexplored.

This study aimed to evaluate whether integrating LDRP family-centered care with epidural analgesia reduces PPD incidence in primiparas, compared to conventional delivery care. By assessing labor pain, emotional states, and labor outcomes, we sought to clarify the interplay between environmental comfort, pain relief, and postpartum mental health, providing evidence-based insights for optimizing perinatal care strategies. We hypothesized that the combination of LDRP family-centered obstetric care and painless delivery would significantly reduce the incidence of PPD in primiparas by improving the childbirth environment, alleviating labor pain, and enhancing maternal psychological well-being compared with conventional delivery care.

MATERIALS AND METHODS

Study design and participants

A retrospective cohort study was conducted at the Ningbo University Affiliated Women and Children’s Hospital from January 2023 to April 2025, enrolling 523 primiparas with singleton, term, cephalic presentation who underwent spontaneous labor and met the criteria for vaginal delivery and epidural labor analgesia.

Inclusion criteria: (1) Primiparas with singleton, term, cephalic pregnancy; (2) Spontaneous onset of labor; (3) Willingness to undergo trial of vaginal delivery without contraindications; (4) No contraindications to painless delivery; and (5) Completion of postpartum psychological assessment.

Exclusion criteria: (1) Induced labor rather than spontaneous onset; (2) Cesarean delivery; (3) Complicated with acute infection, trauma, or other stress events; (4) Severe hepatic or renal dysfunction; (5) Psychiatric disorders or intellectual impairment; (6) contraindications to anesthesia; and (7) Poor compliance.

The participants were divided into a control group (n = 266) and an observation group (n = 257). The control group received conventional delivery care without the use of labor analgesia, while the observation group received LDRP family-centered care combined with labor analgesia. According to the clinical protocol of our institution, all women in antenatal care were uniformly informed upon admission of their right to choose labor analgesia, and the cost of this service was included in the standard delivery package. In contrast, the LDRP family-centered care model required out-of-pocket payment. Hospital staff provided detailed explanations of the procedures, benefits, and potential risks associated with both care models. All participants made voluntary choices, and their decisions were documented in their medical records. This study was approved by the Ethics Committee of the Affiliated Women and Children’s Hospital of Ningbo University.

Process

Conventional delivery care (control group): This intervention included prenatal physical examinations, childbirth guidance, and basic clinical care. Upon admission, term primiparas underwent vital sign monitoring and routine prenatal tests. Prenatal guidance covered postpartum health behaviors and rational dietary allocation. Psychological counseling was provided for those with anxiety or panic; specialized psychological support was arranged for severe psychological conditions by trained counselors and professional nurses. After achieving emotional stability and regular uterine contractions, participants were transferred to the labor room for trial of vaginal delivery. After delivery, participants and their neonates were transferred to the ward once physiological indicators stabilized, and their families were instructed on the care of both mother and neonate.

LDRP family-centered obstetrics care combined with painless delivery (observation group): On the basis of conventional delivery care, the observation group received additional LDRP family-centered care and painless delivery. The LDRP unit was designed with a family-centered approach, equipped with sofas, multifunctional electric beds, televisions, private bathrooms, and 24-hour hot water supply. Continuous family accompaniment was permitted throughout hospitalization. Nurses developed individualized dietary and living plans based on the needs of participants and their families. During labor, midwives and families provided full-course psychological and physical support. After delivery, nurses closely monitored participants’ physical conditions, conducted psychological counseling, detailed breastfeeding knowledge, and maintained a clean and tidy environment in the LDRP unit.

For parturients who requested labor analgesia and were deemed eligible after anesthesiologist evaluation, epidural analgesia was administered with intravenous access established and continuous electrocardiographic and fetal heart rate monitoring performed. Patients were placed in the left lateral position, and epidural puncture was performed at the L2–3 interspace. The epidural space was identified using the loss-of-resistance technique, and an epidural catheter was inserted 3 cm into the epidural space toward the head. Anesthesiologists performed epidural block via puncture at the L2-3 or L3-4 interspace, and through the epidural catheter, 3 mL of 1% lidocaine was injected to exclude intrathecal or intravascular placement, then the analgesia pump was connected. The analgesic solution was 0.1% ropivacaine mixed with 0.5 μg/mL sufentanil, total volume 150 mL. The pump was set with a 10 mL bolus, 60-minute interval, PCA 5 mL per demand, lockout time 25 min, and maximum 30 mL/h. Analgesia was discontinued when the cervix was fully dilated, and additional anesthetic could be administered during episiotomy suture.

Outcome measures

Labor progression: The duration of the three stages of labor was recorded by responsible nurses. The first stage (from onset of labor to full cervical dilation, typically 6-10 hours) is characterized by regular uterine contractions, rupture of membranes, and fetal descent. The second stage (from full cervical dilation to fetal delivery, 1-2 hours) includes spontaneous rupture of membranes, the sensation of defecation, and fetal delivery. The third stage (from fetal delivery to placental delivery, < 30 minutes) is defined by a firm, spherical uterine body, spontaneous extension of the umbilical cord at the vaginal orifice, slight vaginal bleeding, and expulsion of the detached placenta.

Comfort: Comfort level was evaluated using the General Comfort Questionnaire (GCQ) after intervention, including 6 social-cultural items, 10 psychological-mental items, 7 environmental comfort items, and 5 physical comfort items. Each item was scored 1-4 points, with higher scores indicating better comfort. The Cronbach’s alpha for the GCQ in this study was 0.78, indicating high internal consistency and reliability for this sample.

Pain: Pain intensity was assessed using the Visual Analog Scale (VAS) after intervention. Scores ranged from 0 to 10: 0 points (no pain), 1-3 points (mild pain, tolerable), 4-6 points (moderate pain, tolerable), and 7-10 points (severe pain, affecting appetite and sleep). The scale was administered face-to-face by trained nurses 24 hours after delivery.

Mental health: The Childbirth Attitude Questionnaire (CAQ), Pregnancy-Related Anxiety Scale (PAQ), and Edinburgh Postnatal Depression Scale (EPDS) were used to evaluate fear, anxiety, and depression. These assessments were administered 24 hours before and 24 hours after the intervention by trained nurses in a face-to-face setting. The CAQ includes 4 dimensions (hospital intervention and environment, pain injury, loss of control during labor, and child health) with 16 items (4 points each, total 64 points; higher scores indicate greater fear). The PAQ contains 13 items (4 points each, total 52 points; higher scores indicate more anxiety). The EPDS has 10 items (3 points each; ≥ 9 points indicated PPD, ≥ 12 points indicate severe PPD). The Cronbach’s alpha values for the CAQ, PAQ, and EPDS were 0.85, 0.76, and 0.81, respectively, indicating strong internal consistency for these scales.

Delivery outcomes: Oxytocin use, neonatal 1-minute and 5-minute Apgar score, and postpartum blood loss were recorded in detail. The 1-minute Apgar score was used to assess the neonate’s immediate health at birth, while the 5-minute Apgar score was used for a more comprehensive evaluation.

Nursing satisfaction: A hospital-developed questionnaire (5 dimensions including nursing professionalism, patience, and management; total 100 points) was used at discharge: ≥ 80 points (very satisfied), 60-79 points (satisfied), and < 60 points (dissatisfied). The Cronbach’s alpha for this satisfaction questionnaire was 0.82, indicating high internal consistency. The questionnaire was administered at discharge and was designed to capture the overall satisfaction with nursing care provided during hospitalization.

Statistical analysis

Data were analyzed using SPSS 26.0 software. Normality test was performed for all variables. Normally distributed measurement data, expressed as the mean ± SD, were compared using the t-test (for homogeneous variance) or Wilcoxon rank-sum test (for heterogeneous variance). Count data, presented as n (%), were compared using the χ² test. Logistic regression analysis was used to identify factors influencing PPD. Variables included in the regression models were selected based on clinical relevance and the previous literature, focusing on known factors that affect PPD. All variables with a P < 0.05 in the univariate analysis were included in the regression models. To adjust for confounding factors, stepwise regression was used, and potential confounders, such as maternal age, gestational complications, and mode of delivery, were controlled. A P < 0.05 was considered statistically significant.

RESULTS

Comparison of baseline characteristics between the two groups

A total of 523 primiparas were enrolled, with 266 in the control group (conventional delivery care) and 257 in the observstion group (LDRP family-centred care combined with painless delivery). There were no statistically significant differences in baseline characteristics between the two groups (all P > 0.05). Detailed data are shown in Table 1.

Table 1 Comparison of baseline characteristics between the two groups, mean ± SD/n (%).

Characteristic	Control group (n = 266)	Observation group (n = 257)	t/χ2	P value
Age (years)	28.76 ± 4.52	29.13 ± 4.37	0.982	0.327
Gestational age (weeks)	39.25 ± 0.78	39.31 ± 0.82	0.815	0.415
Height (cm)	162.43 ± 5.21	162.78 ± 4.96	0.763	0.446
Pre-pregnancy weight (kg)	54.36 ± 7.82	53.98 ± 8.15	0.564	0.573
Pre-pregnancy BMI (kg/m2)	20.58 ± 2.31	20.42 ± 2.45	0.721	0.471
Educational level			2.135	0.344
High school and below	78 (29.32)	75 (29.18)
College/associate degree	126 (47.37)	121 (47.08)
Bachelor degree and above	62 (23.31)	61 (23.73)
Occupation			3.268	0.195
Office worker	105 (39.47)	101 (39.30)
Labor worker	82 (30.83)	78 (30.35)
Freelancer	48 (18.05)	49 (19.07)
Others	31 (11.65)	29 (11.28)
Antenatal care visits (times)	8.25 ± 1.63	8.37 ± 1.58	0.794	0.427
History of adverse pregnancy	18 (6.77)	16 (6.23)	0.108	0.743
Family monthly income (RMB)			1.896	0.387
< 5000	65 (24.44)	62 (24.12)
5000-10000	142 (53.38)	138 (53.70)
> 10000	59 (22.18)	57 (22.18)

BMI: Body mass index.

Comparison of labor progression time between the two groups

The duration of the first and second stages of labor in the observstion group was significantly shorter than that of the control group (both P < 0.05). There was no statistically significant difference in the duration of the third stage of labor between the two groups (P > 0.05). Detailed data are shown in Table 2.

Table 2 Comparison of labor progression time between the two groups, mean ± SD.

Labor stage	Control group (n = 266)	Observation group (n = 257)	t value	P value
First stage	438.62 ± 126.75	329.45 ± 82.31	11.573	< 0.001
Latent phase	215.38 ± 68.42	156.27 ± 45.19	9.846	< 0.001
Active phase	223.24 ± 59.61	173.18 ± 38.52	10.217	< 0.001
Second stage	64.83 ± 23.57	37.56 ± 12.49	14.692	< 0.001
Third stage	5.79 ± 1.82	4.65 ± 1.23	7.635	0.052
Total labor duration	509.24 ± 148.36	371.66 ± 95.73	12.308	< 0.001

Comparison of comfort level and pain intensity after intervention between the two groups

After intervention, the GCQ scores of all dimensions (social-cultural, psychological-mental, environmental comfort, and physical comfort) in the observstion group were significantly higher than those of the control group (all P < 0.05) (Figure 1). The VAS score of the observstion group was significantly lower than that of the control group (P < 0.05). Detailed data are shown in Table 3.

Figure 1 Comparison of General Comfort Questionnaire scores between the observation group and the control group. The radar chart presents scores for the five dimensions of the General Comfort Questionnaire (social-cultural, psychological-mental, physical comfort, and environmental comfort), along with the total score. GCQ: General Comfort Questionnaire.

Table 3 Comparison of General Comfort Questionnaire and Visual Analog Scale scores after intervention between the two groups, mean ± SD.

Index	Control group (n = 266)	Observation group (n = 257)	t value	P value
General Comfort Questionnaire
Social-cultural	10.35 ± 2.32	14.18 ± 2.19	17.264	< 0.001
Psychological-mental	22.41 ± 5.26	26.59 ± 6.18	7.835	< 0.001
Environmental comfort	11.57 ± 3.18	18.24 ± 3.42	20.159	< 0.001
Physical comfort	8.73 ± 2.45	12.28 ± 2.53	14.307	< 0.001
Total General Comfort Questionnaire score	53.06 ± 10.89	71.29 ± 11.64	15.682	< 0.001
Visual Analog Scale score	6.82 ± 1.57	2.75 ± 1.21	32.409	< 0.001

Comparison of maternal and neonatal outcomes between the two groups

There were no statistically significant differences in postpartum blood loss (including intrapartum, 1-hour postpartum, and 2-hour postpartum), oxytocin usage rate, neonatal 1-minute Apgar score, neonatal 5-minute Apgar score, neonatal weight, incidence of neonatal asphyxia, intrapartum fever rate, or postpartum urinary retention rate between the two groups (all P > 0.05). The fetal distress rate in the observstion group was lower than that of the control group, but with no statistically significant difference (P > 0.05). Detailed data are shown in Table 4.

Table 4 Comparison of maternal and neonatal outcomes between the two groups, mean ± SD/n (%).

Outcome index	Control group (n = 266)	Observation group (n = 257)	t/χ2 value	P value
Maternal outcomes
Intrapartum blood loss (mL)	146.83 ± 54.72	142.15 ± 47.36	1.028	0.304
1-hour postpartum blood loss (mL)	56.21 ± 19.35	54.38 ± 27.89	0.896	0.371
2-hour postpartum blood loss (mL)	22.15 ± 17.83	19.87 ± 4.62	1.603	0.109
Oxytocin usage	181 (68.05)	155 (60.31)	3.527	0.060
Intrapartum fever	3 (1.13)	6 (2.33)	1.158	0.282
Postpartum urinary retention	5 (1.88)	8 (3.11)	0.867	0.352
Neonatal outcomes
1-minute Apgar score (points)	9.23 ± 0.45	9.31 ± 0.39	1.975	0.049
5-minute Apgar score (points)	9.78 ± 0.21	9.82 ± 0.18	1.896	0.059
Neonatal weight (kg)	3.21 ± 0.43	3.18 ± 0.52	0.725	0.469
Neonatal asphyxia	1 (0.38)	1 (0.39)	0.001	0.975
Fetal distress	7 (2.63)	2 (0.78)	3.206	0.074

Comparison of nursing satisfaction between the two groups

The total nursing satisfaction rate in the observstion group was significantly higher than that of the control group (P < 0.05). Specifically, the observstion group had higher scores and satisfaction rates in all dimensions, including nursing professionalism, nursing patience, environmental comfort, psychological support, and management services, with statistically significant differences compared to the control group (all P < 0.05) (Figure 2). Detailed data are shown in Table 5.

Figure 2 Comparison of satisfaction scores between the observation group and the control group. Error bars represent the standard deviation.

Table 5 Comparison of nursing satisfaction between the two groups, mean ± SD/n (%).

Satisfaction index	Control group (n = 266)	Observation group (n = 257)	t/χ2	P value
Dimension scores (points)
Nursing professionalism	17.25 ± 3.18	24.36 ± 2.85	24.107	< 0.001
Nursing patience	16.89 ± 2.97	23.91 ± 2.54	26.352	< 0.001
Environmental comfort	15.62 ± 3.45	24.58 ± 2.76	28.743	< 0.001
Psychological support	14.38 ± 3.22	23.17 ± 3.01	25.896	< 0.001
Management services	15.93 ± 2.89	22.74 ± 2.63	23.571	< 0.001
Total satisfaction score	79.97 ± 12.63	118.76 ± 10.29	36.825	< 0.001
Satisfaction grade
Very satisfied	85 (31.95)	152 (59.14)	42.869	< 0.001
Satisfied	102 (38.35)	94 (36.58)
Dissatisfied	79 (29.70)	11 (4.28)
Total satisfaction rate (%)	70.30	95.72	42.869	< 0.001

Comparison of mental health between the two groups

The CAQ, PAQ, and EPDS scores in the observstion group were significantly lower than those of the control group (all P < 0.05). The proportions of PPD and severe PPD in the observstion group were lower than those of the control group, with statistically significant differences (both P < 0.05). Detailed data are shown in Table 6.

Table 6 Comparison of mental health indicators between the two groups, mean ± SD/n (%).

Index	Control group (n = 266)	Observation group (n = 257)	t/χ2	P value
Childbirth Attitude Questionnaire score	32.56 ± 5.32	25.18 ± 4.15	16.247	< 0.001
Pregnancy-Related Anxiety Scale score	30.43 ± 6.18	22.35 ± 4.87	15.892	< 0.001
Edinburgh Postnatal Depression Scale score	15.27 ± 3.45	11.08 ± 2.93	13.564	< 0.001
Postpartum depression	89 (33.46)	42 (16.34)	23.578	< 0.001
Severe postpartum depression	37 (13.91)	12 (4.67)	15.203	< 0.001

Identification of factors influencing PPD

Univariate analysis showed that PPD was associated with age, pre-pregnancy body mass index, gestational complications, family accompaniment during labor, painless delivery, LDRP unit use, and nursing satisfaction (all P < 0.05). Logistic regression analysis revealed that gestational complications, no family accompaniment during labor, nursing dissatisfaction, no painless delivery, and no LDRP unit use were independent risk factors for PPD (all P < 0.05). Detailed data are shown in Tables 7 and 8.

Table 7 Univariate analysis of factors influencing postpartum depression, n (%).

Factor	Total (n = 523)	With postpartum depression (n = 131)	Without postpartum depression (n = 392)	t/χ2	P value
Age (years)				4.215	0.040
< 30	312 (59.66)	68 (21.79)	244 (78.21)
≥ 30	211 (40.34)	63 (29.86)	148 (70.14)
Pre-pregnancy BMI (kg/m2)				12.368	< 0.001
< 25	401 (76.67)	82 (20.45)	319 (79.55)
≥ 25	122 (23.33)	49 (40.16)	73 (59.84)
Gestational complications				8.972	0.003
Yes	48 (9.18)	15 (31.25)	33 (68.75)
No	475 (90.82)	116 (24.42)	359 (75.58)
Family accompaniment during labor				36.729	< 0.001
Yes	389 (74.38)	65 (16.71)	324 (83.29)
No	134 (25.62)	66 (49.25)	68 (50.75)
Painless delivery				25.418	< 0.001
Yes	257 (49.14)	32 (12.45)	225 (87.55)
No	266 (50.86)	99 (37.22)	167 (62.78)
LDRP unit use				30.156	< 0.001
Yes	257 (49.14)	30 (11.67)	227 (88.33)
No	266 (50.86)	101 (37.97)	165 (62.03)
Nursing satisfaction				28.943	< 0.001
Satisfied	432 (82.60)	80 (18.52)	352 (81.48)
Dissatisfied	91 (17.40)	51 (56.04)	40 (43.96)

LDRP: Labor-delivery-recovery-postpartum.

Table 8 Multivariate logistic regression analysis of independent risk factors for postpartum depression.

Risk factor	B coefficient	Standard error	Wald χ2 value	P value	OR (95%CI)
Gestational complications (yes)	0.842	0.396	4.517	0.034	2.324 (1.062-5.087)
No family accompaniment	1.125	0.482	5.439	0.020	3.080 (1.193-7.949)
Nursing dissatisfaction	0.867	0.295	8.541	0.003	2.381 (1.335-4.249)
No painless delivery	0.341	0.128	7.015	0.008	1.406 (1.101-1.793)
No LDRP unit use	0.805	0.259	9.632	0.002	2.239 (1.338-3.745)

LDRP: Labor-delivery-recovery-postpartum; OR: Odds ratio.

DISCUSSION

This study demonstrates that the combination of the LDRP family-centered obstetrics care and painless delivery exerts a profound positive impact on reducing PPD in primiparas, while concurrently optimizing labor progression, enhancing comfort, ensuring favorable maternal and neonatal outcomes, and improving nursing satisfaction.

Labor duration is a key factor influencing maternal psychological well-being. In our study, the LDRP group had significantly shorter first and second stages of labor compared to the control group. The LDRP unit’s design, creating a home-like environment, was crucial here. It provided a familiar and secure setting that likely modulated the maternal neuroendocrine system positively, promoting more efficient uterine contractions and cervical dilation[6]. Severe labor pain and stress activate the sympathetic nervous system and lead to marked increases in circulating epinephrine, which has been shown to inhibit uterine contractile activity and reduce uterine blood flow, thereby prolonging labor and increasing maternal physiological and psychological burden[10]. Painless delivery significantly reduces maternal plasma epinephrine levels by alleviating pain and the associated stress response, which in turn may decrease the inhibitory effect of epinephrine on uterine activity and help restore more efficient contractions and cervical dilation[11]. The combination of a supportive LDRP environment and effective pain relief from painless delivery likely works synergistically by reducing excessive stress-induced epinephrine release and maintaining more optimal uterine physiology, thus promoting stronger and more coordinated uterine contractions and more efficient labor progression. Additionally, painless delivery, by effectively alleviating labor pain, reduces the inhibitory effect of severe pain on uterine activity. Prolonged labor is known to increase maternal fatigue and stress, which are key contributors to postpartum mood disorders. Thus, the shortened labor duration achieved through this combination likely mitigates these negative psychological impacts[12].

Comfort during labor is intrinsically linked to mental health, and our GCQ results highlight the comprehensive improvement in comfort with LDRP family-centered care and painless delivery. The social-cultural dimension of GCQ reflects the support and interaction within the labor environment. The LDRP unit, by allowing family members to be present throughout labor, enhances this social support, which is vital for reducing feelings of isolation. The psychological-mental domain improvement stems from the sense of control and security provided by the LDRP setting, which diminishes anxiety related to the unknowns of labor[13]. Environmental comfort was enhanced by the unit’s homelike features, such as private spaces and familiar furnishings, which reduce the stress associated with traditional hospital environments. Physical comfort, as indicated by lower VAS scores, is directly attributable to painless delivery, which minimizes the physical distress of labor. This holistic improvement in comfort acts as a buffer against the development of negative emotions that can lead to PPD, which is consistent with previous research findings[14].

Maternal and neonatal outcomes are paramount in obstetric care, and our findings indicate that the benefits of LDRP family-centered care and painless delivery do not compromise safety. Postpartum blood loss, oxytocin usage, neonatal Apgar scores, and other key indicators showed no significant differences between groups. This suggests that the physiological processes of labor and delivery are not disrupted. The trend towards a lower fetal distress rate in the LDRP group, although not statistically significant, is noteworthy. Effective pain management during painless delivery may improve uterine blood flow, thus reducing fetal hypoxia risk[13,15]. Additionally, the calm environment in the LDRP unit may support better fetal well-being by minimizing maternal stress-induced catecholamine release, which can constrict uterine vessels[16].

Nursing satisfaction is a key indicator of care quality[17], and the LDRP group’s significantly higher satisfaction across all dimensions is telling. The LDRP model enables nurses to provide continuous, individualized care in a dedicated space, fostering a stronger nurse-patient relationship[6]. Painless delivery requires specialized nursing care for analgesia administration and monitoring, which enhances the perception of nursing professionalism and patience[18]. High nursing satisfaction creates a positive caregiving environment, which is essential for reducing maternal anxiety and promoting psychological well-being[19]. This positive interaction between nurses and mothers can also improve communication, ensuring that maternal concerns are addressed promptly, further supporting mental health[2].

Mental health assessments using the CAQ, PAQ, and EPDS consistently showed better outcomes in the LDPR group. Lower CAQ and PAQ scores indicate reduced anxiety related to childbirth and pregnancy, while the lower EPDS score reflects a decreased prevalence of PPD. These results are consistent with the improvements in labor progression, comfort, and nursing satisfaction. The integrated approach of LDRP family-centered care and painless delivery addresses multiple aspects of the childbirth experience, creating a less stressful environment that promotes psychological resilience[4]. The analysis of factors influencing PPD further solidifies these findings. Gestational complications emerged as an independent risk factor, which aligns with previous research showing that medical comorbidities increase the psychological burden on mothers due to concerns about their own and the fetus’s health[4]. The protective effects of family accompaniment, painless delivery, LDRP unit care, and nursing satisfaction highlight the importance of a supportive care environment. Family accompaniment provides emotional support and a sense of security[18]. Painless delivery and the LDRP unit address physical and environmental stressors[6], while satisfactory nursing care ensures that maternal needs are met, all contributing to psychological well-being and reducing the risk of PPD[20].

In conclusion, the combination of LDRP family-centered obstetrics unit use and painless delivery is a robust strategy for reducing PPD in primiparas[21]. It achieves this through multiple interconnected mechanisms: Accelerated labor progression, enhanced comfort, favorable maternal and neonatal outcomes, high nursing satisfaction, and mitigation of risk factors associated with PPD[22]. It is important to note that the economic costs of implementing LDRP unit care and painless delivery are key factors that hospital administrators and policymakers must consider. In terms of hospital management, investment in facilities and nurse training is required; however, by reducing the treatment demand related to PPD, shortening hospital stays, and improving nursing quality, hospitals can achieve long-term economic benefits. For patients, the higher comfort and reduction in PPD provided by LDRP family-centered care and painless delivery lead to sustainable health benefits. For policymakers, promoting the combination of LDRP family-centered care and painless delivery can reduce postpartum mental health issues while lowering societal healthcare costs, offering significant public health value. Therefore, in the long term, the integration of LDRP family-centered care and painless delivery, with support from all parties, will bring substantial benefits to maternal and infant health and social welfare.

Although this study found that combining LDRP family-centered care with painless delivery reduces PPD in primiparas, its single-center design limits external validity. Future research should adopt multi-center designs to enhance sample representativeness, conduct long-term follow-ups to assess sustained maternal mental health benefits, and evaluate the economic costs and social benefits of implementation—providing robust evidence for healthcare administrators and policymakers to support broader adoption and informed decision-making.

CONCLUSION

In conclusion, this study demonstrates that the combination of the LDRP family-centered obstetrics care and painless delivery significantly reduces the incidence of PPD in primiparas. The synergistic effects of these interventions not only promote more efficient labor progression and increase comfort but also significantly improve maternal mental health outcomes. By enhancing nursing satisfaction and reducing the physical and psychological burdens associated with childbirth, this model presents a promising approach to improving both maternal well-being and neonatal outcomes. Clinically, the integration of LDRP family-centered care with painless delivery should be encouraged to improve the childbirth experience and reduce the risk of PPD in primiparas. Future multicenter prospective studies with longer follow-up are recommended to further validate these findings and evaluate their long-term impact on maternal mental health.