Effects of free-position delivery combined with perineal massage on reducing sensitive indicators of care quality in high-risk pregnant women.

AIMS: The aim of this study was to evaluate the impact of free-position delivery combined with perineal massage on nursing-sensitive quality indicators and clinical outcomes in high-risk pregnant women.

METHODS

This retrospective cohort study analyzed clinical data from 223 high-risk pregnant women who underwent vaginal delivery between January 2023 and December 2024. Participants were allocated to either the Traditional Supine Delivery group (TSD, n = 117) or the Free-Position and Perineal Massage group (FPPM, n = 106) based on delivery mode. Baseline characteristics, durations of labor, perineal injuries, postpartum hemorrhage, anesthesia requirements, postpartum complications, neonatal conditions, psychological status, and maternal satisfaction were compared.

RESULTS

Compared with TSD, the FPPM group had shorter active first stage and second stage of labor (5.98 ± 1.25 vs. 6.33 ± 1.21 h; 82.01 ± 8.14 vs. 85.48 ± 7.85 min; both p < 0.05), and a lower rate of perineal lacerations (59.43% vs. 76.07%; p = 0.008), episiotomy (16.04% vs. 27.35%; p = 0.042), and postpartum hemorrhage ≥500 mL (5.66% vs. 13.68%; p = 0.045). FPPM also reduced intrapartum anesthesia requirements and postpartum complications while improved 5-min Apgar scores (9.80 ± 0.35 vs. 9.69 ± 0.42; p = 0.036), maternal satisfaction (69.81% vs. 52.14% very satisfied; p = 0.026), and PTSD symptoms (28.44 ± 2.31 vs. 29.52 ± 2.86; p = 0.002).

CONCLUSION

Free-position delivery combined with perineal massage in high-risk pregnant women is associated with better nursing-sensitive quality indicators, lower rates of perineal trauma and postpartum complications, improved neonatal outcomes, and higher maternal satisfaction compared with traditional supine delivery.