Discuss the effects of labor dance on perceived birth pain, birth satisfaction, and neonatal outcomes.

Discuss the effects of labor dance on perceived birth pain, birth satisfaction, and neonatal outcomes.

Explore 16 (2020) 310�317

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Explore

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Research Letter

The effect of labor dance on perceived labor pain, birth satisfaction, and neonatal outcomes

Bihter Akin, MW, Assist. Prof., PhDa,*, Birsen Karaca Saydam, RN, Assoc. Prof., PhDb

a Selcuk University, Faculty of Health Sciences, Midwifery Department, Konya, Turkey b Ege University, Faculty of Health Sciences, Midwifery Department, Izmir, Turkey

A R T I C L E I N F O

* Corresponding author. E-mail addresses: bihterakin@yahoo.com (B. Akin),

birsenkaracasaydam@gmail.com (B.K. Saydam).

https://doi.org/10.1016/j.explore.2020.05.017 1550-8307/© 2020 Elsevier Inc. All rights reserved.

A B S T R A C T

Objective: This research was conducted to determine the effects of labor dance on perceived birth pain, birth satisfaction, and neonatal outcomes. Design: This is an experimental study. Data were collected under three groups during the active phase of labor: the dance practitioner midwife group (DPMG, comprising 40 pregnant women), the dance practitioner spouse/partner group (DPSG, comprising 40 pregnant women) and the control group (CG, comprising 80 pregnant women). Setting: This study was conducted between 1 April 2017 and 31 October 2017 in Turkey. Participants: This study was administered on pregnant women volunteers with no risk during the active phase of labor. Interventions: During the active phase, pregnant women in DPMG danced with the midwife; pregnant women in DPSG, on the other hand, danced with their spouses/partners throughout the active phase. When vaginal dilatation reached 4 cm and 9 cm, labor pain was measured by employing the visual analog scale (VAS). In the postpartum phase, newborn babies’ first, fifth, and tenth minute Apgar scores and oxygen satu- ration levels were measured and registered. In the first hour after delivery, the Mackey Birth Satisfaction Scale was administered. CG, on the other hand, received only the routine procedures offered in the hospital. Findings: The mean scores of VAS 1 and VAS 2 in DPSG and DPMG were lower than in CG. The fifth and tenth minute Apgar scores and the first, fifth, and tenth minute oxygen saturation levels of the newborns in the experimental groups, as well as the level of birth satisfaction, were significantly higher than in CG. Key conclusions: The study showed a positive effect of labor dancing on the labor process.

© 2020 Elsevier Inc. All rights reserved.

Keywords:

Dance Birth (delivery) Pain Satisfaction Neonatal results
1. Introduction

Labor is a significant process for both pregnant women and their newborns. Pregnant women experience different feelings, such as fear and pain, during labor. Not only does labor pain have negative effects on pregnant women and fetuses, women’s psychological and emotional states have a great effect on levels of perceived pain. 1-6

Therefore, midwives should closely monitor the medical statuses of pregnant women and fetuses, check women’s physical and psycho- logical states, and provide necessary assistance for coping with pain.7

Pharmacological and non-pharmacological methods are used to cope with labor pain. 8-15 Regional and systemic analgesics are preferred as pharmacological methods. 16-18 Of the non-pharmacological methods used, massage, hot and cold therapies, therapeutic touch, breathing techniques, hypnosis, and music are most commonly used.19,20 These

non-pharmacological methods, the analgesic effects of which are explained by gate control and endorphin theory, are all comfortable practices that are easy to use and reliable.21,22 The support provided by people whose company is desired by pregnant women during the labor process is the main factor that improves the effective use of non-phar- macological methods and provides feelings of self-control to pregnant women during the process.20

Another non-pharmacological method that provides massage and mobility with the support of the spouse/partner is the labor dance.23

The labor dance starts in the active labor phase of the first labor stage and continues until the end of the first stage to reduce pregnant women’s pain and provide emotional support. The pregnant women can dance with someone they prefer (spouse/partner, mother, mid- wife, etc.) accompanied by light, calming music. The pregnant woman puts her hands on the shoulders of her partner and sways from left to right while the partner massages the pregnant woman’s sacral area.24 The aim is to increase the effectiveness of the method performed with the spouse/partner’s support, upright position, and massage, apart from the music and body movements, and to provide

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emotional support to the pregnant woman. 25-27 A labor dance that a pregnant woman performs with her partner reduces perceived pain and increases the woman’s satisfaction with birth.25 Yet, there is a limited number of studies regarding labor dance.25 In this study, the effects of labor dance with a midwife and spouse/partner are com- pared differently from previous studies. This study is important as it is the first study comparing the effects of midwife and spouse/partner support for women in the process of labor. This study was conducted to determine the effects of labor dance on perceived labor pain, birth satisfaction, and neonatal outcomes.

2. Materials & Methods

2.1. Design

This experimental and prospective study aims to evaluate the effects of labor dance, which is applied during the active phase of labor, on perceived labor pain, birth satisfaction, and neonatal out- comes. This study was conducted at Urla State Hospital, Izmir, Tur- key, which is affiliated with the Ministry of Health’s Public Hospitals Administration. The study population was taken out of all the preg- nant women who were admitted to the Urla State Hospital for labor between April 2017 and October 2017.

2.2. Participants

The study sample included 160 pregnant women who had the fol- lowing characteristics:

� Those who were admitted to the Ministry of Health Urla State Hospital for labor

� Those whose cervical dilatation was between 4 and 8 cm � Those who had received labor dance training by attending prena- tal training with their spouses/partners in the perinatal period (Only DPSG).

� Those who met the inclusion criteria (volunteering, term preg- nancy (37-41 gestational weeks), single fetus, no pregnancy com- plications (oligohydramniosis and polihydramniosis, placenta previa, pre-eclampsia, premature rupture of membrane, presen- tation anomalies, intrauterine growth retardation, intrauterine death, macrosomic baby, fetal distress, etc.).

We excluded patients if

� They underwent cesarean section � Labor was inducted � Narcotic analgesics were used

The dance practitioner spouse/partner group (DPSG) included 40 pregnant women who signed the informed consent form, the dance practitioner midwife group (DPMG) included 40 pregnant women and midwives who had received labor dance training, and the control group included 80 pregnant women who were subjected to routine treatment without dance. The sample size was determined using power calcula- tions G*Power 3, taking into account previous studies on labor dance for satisfaction. Estimates of effects were derived from the findings of Abdo- lahian et al. (2014), who reported on the mean satisfaction of a experi- mental group (4.66 § 0.66) and a control group (4.13 § 1.04).25 We aimed at detecting a similar difference. The number of samples in each group (experimental and control) was 80. The power analysis showed that the study sample size had 99% power with a = .05.

2.3. Data collection tools

A visual analog scale (VAS) was administered to determine preg- nant women’s perceived labor pain when cervical dilatation was

4 cm, and the VAS was readministered when cervical dilatation was 9 cm. Electronic fetal monitoring was performed, and fetal heart rate was examined and recorded on a partogram by a researcher every thirty minutes. The Mackey Childbirth Satisfaction Rating Scale was administered in the first hour after the delivery to determine preg- nant women’s satisfaction levels. Newborns’ first minute, fifth min- ute, and tenth minute Apgar scores were evaluated and recorded. Newborns’ first minute, fifth minute, and tenth minute oxygen satu- ration levels were measured on their right hands, and the results were recorded. Only routine practices were performed with the con- trol group, and data were recorded as in the experimental groups (Figure 1).

2.4. Data collection procedures and labor dance

The pregnant women and their spouses/partners were trained in labor dance during prenatal training (for DPSG). In order not to affect the results the study, training was given about labor dance to women and their spouses/partners without giving any information about the aim of study and the effects of labor dance on labor pain. The preg- nant women and their spouses/partners who wanted to perform the practice were asked to inform the researcher when the labor started. The researcher stayed with the pregnant women and their spouses during the practice and labor process. The pregnant women started to dance with their spouses during the active phase of the labor pro- cess, accompanied by meditation music in a dim, otherwise silent environment. The spouse or partner massaged the pregnant women’s sacral areas while dancing. During the active phase of labor, the preg- nant women in DPMG danced with the midwives who were atten- dant in the delivery room and who were monitoring the pregnant women’s statuses. Only routine practices were performed with the control group (electronic fetal monitoring was performed, and fetal heart rate was examined and recorded on a partogram by a researcher every thirty minutes).

2.5. Analysis

Data analysis was conducted using the Statistical Package for Social Science 11.0. Descriptive data regarding pregnant women were pro- vided as numbers and percentage distributions. Chi-squared tests were used for categorized/classified variables. The Shapiro-Wilk test was employed to determine certain obstetrical traits of pregnant women, the total sum of dance time, perceived level of pain and birth satisfaction among mothers, and whether or not data revealed a nor- mal distribution prior to comparing the Apgar and oxygen saturation levels of the newborns. Based on these test results, the Kruskal-Wallis test was administered to analyze abnormally distributed data. Median, minimum-maximum, mean, and standard deviation values are as demonstrated. A post-hoc test was performed for further analysis in case of a difference between the groups after the Kruskal-Wallis test. Data were evaluated at a p < 0.05 threshold for statistical significance. 2.6. Ethical considerations Ethical approval for this study was obtained from the Ege Univer- sity Research Ethics Committee, reference 24.03.17/ 17-3/8. Clinical trials of the research were registered under the code NCT04196660. 3. Results The pregnant women’s mean ages were 26.32 § 4.76 years, 27.45 § 4.57 years, and 27.38 § 3.42 years in DPSG, DPMG, and CG, respectively. As shown in Table 1, DPSG, DMPG, and CG had no statistically significant differences in demographic features and were homogeneous. Pregnant women that met research inclusion criteria and volunteered to take part in the research (N =187) Midwife group practicing dance (n = 44) Control group (n = 87)Spouse/partner group practicing dance (n = 57) Excluded from the research (11 women that the researcher did not attend during delivery, 3 women giving birth in a different institute, 2 women who quit the research, 1 woman who underwent caesarean delivery) Excluded from the research (1 woman who did not deliver by dancing with the midwife, 3 women who underwent caesarean delivery) Excluded from the research (7) Having caesarean delivery (3) Women who quit the research (4) Assignment of women who met the inclusion criteria and agreed to perform labor dance with a midwife in the dance practitioner midwife group (DPMG) Assignment of women who met the inclusion criteria and did not want to perform a labor dance When cervical dilatation was 4 cm, labor dance started with women’s spouses/partners, with intermittent dance during the labor process When cervical dilatation was 4 cm, labor dance started with women’s midwives, with intermittent dance during the labor process Routine care was offered (cervical dilatation and fetal heart rate was examined and recorded) VAS practice when cervical dilatation was 4 cm (for all groups) VAS practice when cervical dilatation was 9 cm (for all groups) In the postpartum phase, data were collected about the newborns by administering a birth satisfaction scale in the first hour after birth (for all groups). Analyzed (n = 40) Analyzed (n = 40) Analyzed (n = 80) Assignment of women who met the inclusion criteria and received labor dance training by attending prenatal training in the dance practitioner spouse/partner group (DPSG) Figure 1. Practice Stages of the Research 312 B. Akin and B.K. Saydam / Explore 16 (2020) 310�317 Table 1 Distributions Based on Pregnant Women’s Age Groups and Educational Statuses Variables* GROUPS Dance Practitioner Spouse/Partner Group Dance Practitioner Midwife Group Control Group Total n % n % n % n % Age Group < 20 Years Old 5 12.5 0 0 0 0 5 3.1 20-24 Years Old 10 25 12 30 24 30 46 28.8 25-29 Years Old 16 40 16 40 36 45 68 42.5 30-34 Years Old 9 22.5 10 25 20 25 39 24.4 > 35 Years Old 0 0 2 5 0 0 2 1.2 x2 = 1.228 p = 0.351 Educational Status Literate/Primary School 2 5 4 10 4 5 10 6.3 Middle School 0 0 8 20 22 27.5 30 18.7 High School 22 55 17 42.5 37 46.3 76 47.5 University and above 16 40 11 27.5 17 21.3 44 27.5 x2 = 16.120 p = 0.013 Occupational Activity Worker 4 10 8 20 14 17.5 26 16.25 Government Official 11 27.5 10 25 11 13.75 32 20 Self-employment 9 22.5 9 22.5 16 20 37 23.125 Housewife 16 40 13 32.5 39 48.75 65 40.625 x 2 = 6.425 p= 0.377 Smoking Status Before Pregnancy Smoking 13 32.5 7 17.5 26 32.5 46 28.75 No smoking 27 67.5 33 82.5 54 67.5 114 71.25 x 2 = 3.295 p= 0.193 TOTAL 40 100.0 40 100.0 80 100.0 160 100.0

* Number and percentage distributions of the groups are presented. Chi-Squared (p-value) methods were used for categorized/classified data, respectively.

B. Akin and B.K. Saydam / Explore 16 (2020) 310�317 313

All groups were found to be similar in number of pregnancies, week of pregnancy, cervical dilatation at the time of hospitalization, and the duration of the active phase (Table 2).

The median total labor dance durations were 48 and 56 minutes in DPSG and DPMG, respectively. These two groups were similar in terms of total dance durations (p = 0.873). The median resting times were 113 and 132 minutes in DPSG and DPMG, respectively, and these two groups were similar in terms of resting times (p = 0.376) (Table 3).

The mean scores of perceived pain between groups were evalu- ated twice, when cervical dilatation was 4 cm and when cervical dila- tation was 9 cm (Table 4). The difference in the pain scores when cervical dilatation was 4 cm was found to be significant (p = 0.043). When cervical dilatation was 9 cm, the difference was measured with respect to perceived labor pain level between groups (p = 0.014). In further analyses (by post hoc Tukey test) this difference was attributed to the significant lowness of DPSG and DPMG pain lev- els in contrast to CG (p = 0.01). The median first minute Apgar score was found to be 9 in DPSG, DPMG, and CG, and there was no

Table 2 Pregnant Women’s Distributions Based on the Number of Pregnancies, Week of Pregn Active Phase

Variables*

Dance Practitioner Spouse/Partner Group n = 40

Median (Min-Max) Mean§SD Number of Pregnancies 1 (1-2) 1.47§0.50 x2 = 0.403 p = 0.817 Week of Pregnancy 40.0 (38-41) 39.52§0.87 x2 = 6.001 p = 0.050 Cervical Dilatation

at Hospitalization (cm) 2 (1-3) 2.32§0.61

x2 = 2.759 p = 0.252 Duration of Active Phase (hours) 5.5 (3-12) 6.77§2.64

x2 = 0.905 p = 0.636 * The Kruskal-Wallis H (x2 value) method was used and is shown as the median

deviation.

statistically significant difference between the groups (p = 0.91). The median fifth minute Apgar score was found to be 10 in DPSG, 9 in DPMG, and 8 in CG, and this difference was statistically significant (p < 0.01). Further analysis (by post hoc Tukey test) found that this dif- ference arose from the significantly higher Apgar scores of DPSG compared to those of DPMG and CG. The median tenth minute Apgar score was found to be 10 in DPSG, DPMG, and CG (p = 0.06). Newborns’ first minute oxygen saturation levels were 89 in the experimental groups (DPSG, DPMG) and 88 in the control group, and there was a statistically significant difference between the groups (p = 0.05). The fifth minute oxygen saturation levels were 99 in the experimental groups and 94 in the control group, and the tenth min- ute oxygen saturation levels were 99 in the experimental groups and the control group. There was a statistically significant difference in the fifth minute and tenth minute oxygen saturation levels between the groups (p < 0.01) (Table 5). In order to analyze the birth satisfaction of the mothers, the Mackey Birth Satisfaction Scale was administered to compare the total mean scores and subdimensions of the scale. Among DPSG, ancy, Cervical Dilatation at the Time of Hospitalization, and the Duration of the GROUPS Dance Practitioner Midwife Group n = 40 Control Group n = 80 Median (Min-Max) Mean§SD Median (Min-Max) Mean§SD 1 (1-4) 1.52§0.71 1 (1-4) 1.46§0.65 39.6 (38-41) 39.57§0.71 39.0 (37-41) 39.23§0.78 3 (1-4) 2.55§0.84 2 (1-4) 2.36§0.71 6.0 (3-12) 6.35§2.20 6.0 (3-20) 6.72§2.34 value with minimum and maximum values in parentheses and mean, standard Table 3 Findings Regarding the Total Dance and Resting Durations of the Pregnant Women in the Experimental Groups Variables* GROUPS Dance Practitioner Spouse/Partner Group n = 40 Dance Practitioner Midwife Group n = 40 Median (Min-Max) Mean§SD Median (Min-Max) Mean§SD Total Dance Duration (minutes) 48 (43-124) 63.30§24.33 56 (36-95) 60.68§20.22 z = -.159 p = 0.873 Total Rest Duration (minutes)** 113 (58-216) 140.96§57.52 132 (67-216) 143.01§22.44 z = -.886 p = 0.376 * The Mann-Whitney U Test (Z value) was performed. ** Resting time included activities such as sitting in bed, lying, sleeping, eating, and showering, which the pregnant women per- formed when they were not dancing. Table 4 Pregnant Women’s Distributions of Perceived Pain Scores When Cervical Dilatation Was 4 cm. and When Cervical Dilatation Was 9 cm. Variables GROUPS Dance Practitioner Spouse/ Partner Group n = 40 Dance Practitioner Midwife Group n = 40 Control Group n = 80 Statistical Value Median (Min-Max) Mean§SD Median (Min- Max) Mean§SD Median (Min-Max) Mean§SD P Value When cervical dilatation was 4 cm (mm.)* 5.00 (3-7) a 5.02§1.14 5.00 (2-8)b 5.35§1.87 5.00 (3-8)c 5.61§1.34 0.043ac** Tenth Minute 10 (9-10) 9.92§0.26 10 (9-10) 9.82§0.38 10 (9-10) 9.75§0.43 0.06 Oxygen Saturation Levels First Minute 89 (84-98) 88.85§3.07 89 (82-98) 88.95§2.80 88 (84-97) 87.72§2.33 0.05 a,b>c Fifth Minute 99 (97-100) a 98.92§0.76 99 (92-99) b 97.25§2.67 94 (86-99) c 93.47§3.99 <0.01a,b>c Tenth Minute 99 (99-100) a 99.50§0.50 99 (94-100) b 99.10§1.54 99 (92-100) c 97.70§2.70 <0.01a,b>c

* Since the data displayed a normal distribution according to the Shapiro-Wilk test, the median, minimum, maximum values are listed after the results of the Kruskal-Wallis test. ** Post hoc Tukey test

314 B. Akin and B.K. Saydam / Explore 16 (2020) 310�317

DPMG, and CG, the subdimensions of satisfaction with the self, the baby, the midwife, the doctor, and the birth were respectively found to have a statistically significant difference from the total mean score of birth satisfaction (p < 0.01) (Table 6). In further analyses (by post hoc Tukey test) this difference was attributed to the result that in the experimental groups (DPMG and DPMG), the subdimension values of satisfaction with the self, the baby, the midwife, the doctor, and the birth were above the values measured in the control group at a statis- tically significant level (p < 0.05) (Table 6). 4. Discussion In light of the findings obtained in this research, it was deter- mined that labor dance positively impacted perceived labor pain and neonatal outcomes as measured by the newborns’ Apgar scores and oxygen saturation levels and the mothers’ birth satisfaction levels. Abdolahian et al. (2014) reported a VAS score of 6.89 in the exper- imental groups and 8.29 in the control group before the labor dance in a study conducted to determine the effects of labor dance on birth satisfaction and labor pain. Pregnant women’s pain levels were re- evaluated at the 30th, 60th, and 90th minutes of labor dance. The per- ceived pain levels were significantly lower in the experimental groups compared to the control group.25 Erdogan et al. (2017), in a study that analyzed the effects of back-massage applied to pregnant women in the first phase of labor, drew a comparison between VAS scores at the latent, active, and transmission phases of labor. Com- pared to the control group, all of the VAS scores were measured as lower in the massage group.28 This study and previous studies sug- gest that pregnant women felt less pain and needed less analgesic aid when supportive care and non-pharmacological methods were applied. There was no difference in terms of receiving care from spouses or midwives. A labor dance performed with a spouse may have positive effects on newborns’ fifth minute Apgar scores (Table 5). There was no dif- ference in newborns’ first minute Apgar scores between groups, but the fifth minute and tenth minute Apgar scores were a bit higher in DPSG, which means that the bond between the spouse/partner and the pregnant woman positively affects newborns. Methods that were Table 6 Comparison of Mothers’ Birth Satisfaction Sub-Scale and Mean Scale Scores Variables* GROUPS Dance Practitioner Spouse/Partner Group Dance Practitioner Midwife Group Control Group Statistical Value Median (Min-Max) Mean§SD Median (Min-Max) Mean§SD Median (Min-Max) Mean§SD x2 Value P Value Self-Satisfaction, Total Score 45 (38-45) a 44.22§1.64 44 (39-45) b 43.85§1.47 43 (33-45) c 41.10§4.13 34.136 <0.001 a>b,c** Satisfaction with the Baby, Total Score

15 (13-15) a 14.42§0.84 15 (12-15) b 14.35§0.80 13 (9-15) c 13.40§1.34 25.374 <0.001a,b>c

Satisfaction with the Midwife, Total Score

45 (43-45) a 44.82§0.50 45 (41-45) b 44.60§1.21 45 (39-45) c 43.41§2.28 15.541 <0.001a,b>c

Satisfaction with the Physician, Total Score

39 (35-40) a 38.77§0.91 40 (37-40) b 39.27§1.21 40 (32-40) c 38.56§2.37 19.008 <0.001a,b>c

Satisfaction with the Birth, Total Score

15 (14-15) a 14.95§0.22 15 (13-15) b 14.87§0.40 15 (12-15) c 14.60§0.70 22.600 <0.001a,b>c

Total Mean Score of the Child- birth Satisfaction Rating Scale

159 (143-160) a 157.20§3.67 157 (151-160) b 157.07§2.84 156 (135-160) c 151.07§9.55 12.723 0.002a,b>c

* A Kruskal-Wallis Test was administered since the data distribution was not normal. ** Post hoc Tukey tes

B. Akin and B.K. Saydam / Explore 16 (2020) 310�317 315

applied in previous studies, which included interventions for reduc- ing labor pain, had no negative effects on newborns’ Apgar scores. Regarding the implementation of the practice, no difference in the Apgar scores was present between the infants of the different groups of pregnant women.22,29 Lawrence et al. (2013) investigated twelve studies in a meta-analysis to examine the effects of maternal mobili- zation on labor and found only one study that demonstrated that newborns’ fifth minute Apgar scores in the experimental groups were higher than in the control group.9 Support, mobility, and non- pharmacological methods provided to women during labor reduced the anxiety of the pregnant women, shortened the labor duration because of the pressure on the cervix, and positively affected the newborns.9,10,22 Newborns in the experimental groups had higher first minute, fifth minute, and tenth minute oxygen saturation levels than did the control group. Previous studies that examined the effects on newborns of non-pharmacological methods used in the manage- ment of labor pain have evaluated their mean Apgar scores and sta- tuses regarding hospitalization in the intensive care unit.9,10,22 The first and fifth minute oxygen saturation levels in this study agree with those of previous studies. Not only did the labor dance have a positive effect on newborns’ fifth and tenth minute oxygen saturation levels, but it also ensured a greater effect when the practice was per- formed with a spouse.

Findings obtained in this study also reveal that labor dance ren- ders positive effects not only on newborn babies but also on women giving birth (Table 6). One of the most crucial components of labor dance is the physical and emotional support offered during labor. Previous studies that have examined support during pregnancy, labor, or the postpartum period state that pregnant women or women who recently gave birth always need social support, yet the support of the spouse or partner is particularly significant. Another study stated that back massage applied to pregnant women during labor increased mothers’ birth satisfaction.30 Abdolahian et al. (2014) found the birth satisfaction of pregnant women who danced with their spouses to be significantly higher than those who did not dance.25 These study results are compatible with the literature. Labor dances performed with spouses helped women to be satisfied with the labor experience. Ferrer (2016) compared the effects of humanistic and medical care models on women’s birth satisfaction during the intrapartum period. In a humanistic care model, women are allowed to be overseen by their partners and/or another person in the phases of labor, birth, and after birth. At the same time, it is recommended to avoid redundant interventions (constant monito- rization, intravenous infusion, amniotomy, etc.). The study found that women who were attended to under the humanistic care model had significantly higher levels of satisfaction with their health

professionals, their babies, and their spouses than those who were attended to under the biomedical care model.31 The humanistic care model displays similarities to mother-friendly hospital practices. All pregnant women were provided care using mother-friendly hospi- tal practices. Satisfaction subscales, except for satisfaction with the physician and the total scale score of the experimental groups, were higher than those of the control group. Mother-friendly hospital practices have positive effects on mothers’ satisfaction; further- more, labor dance enhances this positive effect. Similarly, another study stated that pregnant women who underwent the labor pro- cess with the support of health professionals or relatives in a spe- cially prepared room were more satisfied than were pregnant women who had routine care.32 Smith stated that aromatherapy, music, and massage did not affect women’s birth satisfaction; how- ever, hypnosis positively affected their satisfaction.10 Sandall et al. (2016) examined 15 studies of 17,674 pregnant women, comparing their care with other care models under the leadership of midwives. Services such as evaluating low-risk pregnant women’s needs during the antepartum, intrapartum, and postpartum periods; care planning; and referring patients to relevant specialists were provided under the leadership of midwives. This kind of care was provided by health pro- fessionals such as obstetricians, family physicians, and obstetrician nurses in other care models. The satisfaction status of women who received care under the leadership of midwives was found to be high compared to the women in other groups.33 The concerns of the preg- nant women and their partners and spouses increased when the mid- wives left them alone during the labor process. The midwives constantly provided personal care, which pleased the pregnant women. This satisfaction helped them to perceive the clinical environ- ment and all employees positively and to enhance psychological and physiological healing.34 It is highlighted that pregnant women in the experimental groups were never left on their own during the labor process in this research, and the non-presence of constant monitoring by the spouse or midwife affected women’s birth satisfaction in a posi- tive way.

Labor dance is a novel method that helps pregnant women, fami- lies, and midwives cooperate during labor and contributes to preg- nant women’s spouses/partners being able to manage pain experiences during the first phase of labor. Since labor dance is prac- ticed with one’s spouse/partner and midwives, this study was con- ducted in a mother-friendly hospital that allows spouses to be in the delivery room. In order to popularize labor dance and help pregnant women’s families contribute to intrapartum care, it is suggested to conduct dance practices in a wider sampling with other attendants a pregnant women would ask for (mother, sister, or friend) and in insti- tutions that are not mother-friendly.

316 B. Akin and B.K. Saydam / Explore 16 (2020) 310�317

5. Conclusion

The results of this study demonstrated that labor dance positively affected labor pain, birth satisfaction, and neonatal results. The labor dance was important; however, whether dancing occurred with a spouse/partner or midwife did not affect the study results. The preg- nant women wanted their midwives’ company as much as they needed their families’ presence during labor, which is one of the most special moments of their lives. This study supports the “Mid- wives, Mothers, and Families: Partners for Life” theme of the 2017 International Confederation of Midwives (ICM).

Author Contributions

B. A. and B. K. S. designed the study, analyzed the data, and drafted the manuscript; B. A. conducted the data collection and drafted the manuscript, as well as conducted the study and data collection. All the authors read and approved the final manuscript.

Ethical Approval

All participants gave written consent to participate. Ethical approval was obtained from the Ege University Research Ethics Com- mittee reference (24.03.17/ 17-3/8). All participants gave written consent to anonymised quotes being used in publications.

Funding Sources: There is no funding in the study Clinical Trial Registry and Registration number: NCT04196660

Declaration of Competing Interest

The authors declare that there is no conflict of interest.

Acknowledgement

This article was derived from a doctoral thesis. This paper was presented as an oral presentation at the 47th Global Nursing and Healthcare Conference in London between 1 and 3 March 2018.

Supplementary materials

Supplementary material associated with this article can be found in the online version at doi:10.1016/j.explore.2020.05.017.

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Bihter Ak{n She worked as a midwife for about 15 years. She is currently working as a faculty member in midwifery department. There are published many articles and book chapters on birth, birth pain, prenatal education.

B. Akin and B.K. Saydam

Birsen Karaca Saydam Assoc. Prof Birsen karaca Saydam, who was borned in Karşıyaka, _Izmir. Her professions are reproductive health, infertility, obstetrics and gynecologic nursing, gynecological oncology nursing, gender equality in society and health education. Currently she has been con- ducting the Assos. Prof. Position in Ege University Faculty of

lore 16 (2020) 310�317 317

Health Science Midwifery Department.

The effect of labor dance on perceived labor pain, birth satisfaction, and neonatal outcomes
1. Introduction
2. Materials and Methods
2.1. Design
2.2. Participants
2.3. Data collection tools
2.4. Data collection procedures and labor dance
2.5. Analysis
2.6. Ethical considerations
3. Results
4. Discussion
5. Conclusion
Author Contributions
Ethical Approval
Declaration of Competing Interest
Acknowledgement
Supplementary materials
References

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