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

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.

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

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

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

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

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

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.