Chapter

Labor and Delivery Care: The Four

Stages
Fatemeh Ahadi Yulghunlu

Abstract

In labor and delivery care, we need to have a single and broad view of the total
process of labor, delivery, and neonate birth. Key considerations during labor include
the four “P’s”: power, pass, passenger, and psyche. These elements are vital for
assessing the effectiveness of contractions, the passage through the birth canal, and
the condition of the fetus, respectively. Continuous monitoring of the fetal heart rate
is also crucial to ensuring the well-being of the unborn child throughout the labor
process. Also, in delivery care, recognizing the time of completion of the second stage
and preparing the mother for pushing and paying attention to the descent of the fetus
and the need to perform an episiotomy and finally the birth of the neonate. All these
steps require a systematic approach, and it is predetermined that we know the normal
process to recognize the abnormal cases and take the correct action.

Keywords: midwifery care, labor care, delivery care, progress of labor, fetal monitoring

1. Introduction

Labor and delivery care is a critical aspect of maternal health, encompassing

the processes and practices involved in supporting women through childbirth. This
period is marked by significant physiological and emotional changes, requiring
comprehensive and compassionate care to ensure the well-being of both the mother
and the newborn [1].
The labor journey begins with the onset of regular contractions, leading to the
dilation and effacement of the cervix. This process is divided into four stages: the first
stage involves early and active labor, the second stage culminates in the delivery of the
baby, the third stage concludes with the delivery of the placenta, and the fourth stage
is the first two hours after delivery, which is called recovery [1, 2].
Each stage presents unique challenges and requires specific interventions to man-
age pain, monitor fetal well-being, and address any complications that may arise.
Effective labor and delivery care is grounded in evidence-based practices that
prioritize safety, minimize unnecessary interventions, and promote a positive birth
experience. Healthcare providers, including obstetricians, midwives, and nurses, are
pivotal in offering continuous support, education, and medical care to mothers [3].
Knowing the processes of the labor period (the period with labor pains), the needs
of the mother and her care, as well as the birth process, the way of delivery, and the

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necessary interventions enable health professionals, especially midwives, who are

the standard of birth attendants, to guide and manage labor and delivery well and
perform the necessary interventions at the right time, so that the mother and her fetus
can finish this period with the least complications [4].
Labor has four stages that start with labor pains and finally end with delivery.
Now, in this chapter, these necessary steps and interventions are explained.
Ultimately, labor and delivery care is a testament to the dedication and expertise
of healthcare professionals, ensuring that every mother and newborn receives the
highest standard of care during one of life’s most transformative moments.

2. The first stage of labor

Labor is defined by intense and painful uterine contractions that facilitate cervi-
cal dilation and enable the descent of the fetus through the birth canal. However,
significant preparatory processes occur in both the uterus and cervix well in advance
of this stage. Throughout the initial 36–38 weeks of a typical gestation period, the
myometrium remains in a preparatory state, characterized by unresponsiveness.
Simultaneously, the cervix initiates an early remodeling phase while preserving its
structural integrity. Following this period of uterine quiescence, a transitional phase
commences, during which the myometrium’s unresponsiveness is temporarily lifted
and the cervix undergoes processes of ripening, effacement, and a reduction in
structural cohesion [5].
The first stage of childbirth includes two phases:

2.1 E
 arly labor

Early labor, also known as the latent phase, is the initial part of the first stage.
During this phase, the relaxation of the uterus is disrupted, the cervix becomes soft,
and the receptors in the myometrium wall of the uterus respond to uterotonics. Then
contractions begin to occur at regular intervals, although they are usually mild and
may not be very painful. The cervix starts to soften, thin out (efface), and dilate up
to 6 centimeters. This phase can last for several hours to days, especially for first-time
mothers [6].
During early labor, it is common for women to experience a range of symptoms,
including:

• Mild to moderate contractions that may feel like menstrual cramps.

• A clear or slightly bloody discharge from the vagina, known as the mucus plug.

• Backache or a sensation of pressure in the lower abdomen.

To manage discomfort during early labor, women are encouraged to stay active,
practice relaxation techniques, and stay hydrated. Many women spend this phase at
home until contractions become more intense and frequent [7].
The following strategies may be effective in managing labor pains and associated
discomfort:

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• Engage in a cycle of rest and ambulation: It is advisable to alternate between

periods of rest and movement while also experimenting with various positions to
alleviate discomfort.

• Practice slow, deep breathing techniques: It is important to remain relaxed dur-

ing contractions; therefore, focus on breathing through each contraction to the
best of your ability.

• Maintain adequate hydration: Ensure that you are consuming sufficient fluids
and consult with your healthcare provider regarding the appropriateness of light
eating or the necessity of fasting during this period [8].

• Consider engaging in hydrotherapy, as activities such as bathing, showering,

or swimming in a pool may provide relief. It is advisable to consult with your
healthcare provider before undertaking these activities, particularly if your
amniotic membranes have ruptured.

• Additionally, prioritize self-care by utilizing aromatherapy, music, and your

support network to facilitate positive distractions [9].

2.2 A
 ctive labor

Active labor is the second phase of the first stage and is marked by more intense
and frequent contractions. During this phase, the cervix dilates from 6 to 10 centime-
ters. Contractions become stronger, closer together, and more regular. This phase is
typically shorter than early labor but can still last several hours [10].
As active labor progresses, women may experience:

• Stronger and more painful contractions.

• Increased pressure in the lower back and pelvis.

• Possible rupture of the amniotic sac (water breaking).

It is usually recommended to go to the hospital or birthing center during active

labor. Healthcare providers will monitor the mother and baby closely, providing sup-
port and pain relief as needed [11].

2.3 M
 idwifery care

This section documents the woman’s name along with essential information neces-
sary for assessing her baseline characteristics and risk status upon admission for labor.
Additionally, pertinent demographic and labor-related factors, including the woman’s
age, gestational age, serological results, hemoglobin levels, blood type and Rh factor,
referral status and rationale, and symphysis-fundal height, should be incorporated
into the woman’s medical record [3].
Table 1 shows how to assess the variables discussed in this section, as well as the
appropriate manner for documenting the acquired information [3].

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Variable Step 1: Assess Step 2: Record

Name Ask the woman her full • Record the woman’s full name and verify that it matches
name. the name on her medical record.

Parity Extract from medical • Use the local coding system to record parity, e.g., Parity
records the number of (or P) = number of babies born (after the local definition
times the woman has given of viability).
birth to a baby after the age
of viability (as per local
guidelines).

Labor onset Was the onset of labor • Record “Spontaneous” if the woman achieved the active
spontaneous or induced first stage of labor without any artificial stimulation of
(using any artificial labor onset (either through pharmacological or nonphar-
means)? macological means).
• Record “Induced” if the onset of labor was artificially
stimulated by administering oxytocin or prostaglandins to
the pregnant woman, artificially rupturing the amniotic
membranes, applying a balloon catheter into the cervix,
or any other means.

Active labor On what date was the • Date of active labor diagnosis. Use local format to record
diagnosis active first stage of labor dates (e.g., dd/mm/yy, mm/dd/yy, or dd/ mm/yyyy).
diagnosed?

Ruptured On what date and at • Date and time [hh: mm] that rupture of membranes
membranes what time were amniotic occurred. These data could be reported by the woman or
membranes ruptured (if her companion, or they could be extracted from medical
membranes have ruptured records if membranes ruptured after admission but before
before admission)? initiating the LCG.
• Use local format to record time.
• Record “U” or “unknown” if rupture of membranes is
confirmed and the woman cannot report the date and/ or
time and there is no documentation in the medical record.

Risk factor Risk factors • Known obstetric, medical, and social risk factors with
implications for care provision and potential outcome of
labor management. For example, preexisting medical con-
ditions (e.g., chronic hypertension), obstetric conditions
(e.g., pre-eclampsia), woman’s advanced age, adolescent
pregnancy, preterm labor, and group B Streptococcus
colonization.
Table 1 is modified from WHO Labor Care Guide User’s Manual Copyright 2020.
LCG: labor care guide.

Table 1.
Guidance for completing Section 1.

2.4 S
 pecial considerations in the first stage of childbirth include

2.4.1 C
 ontrol of labor pains

2.4.1.1 N
 onmedical methods

1. Breathing techniques: Practicing deep, rhythmic breathing can help manage

pain and keep calm. Studies have shown that controlled breathing can reduce the
perception of pain and anxiety during labor [12].
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2. Movement and positioning: Changing positions, walking, or swaying can

help ease discomfort and speed up labor. Research indicates that upright posi-
tions and movement can reduce the duration of labor and the need for pain
relief [12].

3. Water therapy: Taking a warm bath or shower can relax muscles and reduce pain.
Hydrotherapy has been found to decrease pain intensity and improve satisfaction
with the childbirth experience [13].

4. Massage and counter pressure: Having a partner or doula apply pressure to your
lower back or massage tense areas can provide significant relief. Evidence sug-
gests that massage can reduce labor pain and anxiety [14].

2.4.1.2 M
 edical methods

1. Epidural analgesia: This is a common and effective method for pain relief during
labor. It involves injecting anesthetic near the spinal cord to block pain. Studies
show that epidurals provide significant pain relief and are safe for both mother
and baby [15].

2. Nitrous oxide: Also known as laughing gas, this can be inhaled during contrac-
tions to reduce pain and anxiety. Research supports its effectiveness and safety
for pain management during labor [16].

3. Opioids: These can be administered through an IV or injection to help manage

severe pain. While effective, they can have side effects and are typically used
when other methods are insufficient [17].

2.4.1.3 P
 sychological support

1. Continuous labor support: Having a doula or continuous support person

can ­significantly reduce the need for pain relief and improve overall birth
­outcomes [18].

2. Hypnobirthing: This involves using hypnosis techniques to manage pain

and anxiety. Studies have shown that hypnobirthing can reduce the need for
­medical pain relief and improve the childbirth experience [19, 20].

2.4.2 C
 hecking the progress of labor

Monitoring the progress of labor is essential to ensuring the health and safety
of both the mother and the baby. Here are some key methods used to check labor
progress:

2.4.2.1 C
 ervical dilation and effacement

• Cervical dilation: Cervical dilatation speed is 1.2 cm per hour in nulliparous

women and 1.5 cm per hour in multiparous women. In case of prolongation or
arrest of dilatation, the causes, such as sero-pelvic disproportion (CPD), should
be investigated [1].
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• Effacement: This refers to the thinning of the cervix, measured in percentages from
0–100%. Complete effacement (100%) means the cervix is fully thinned out [1].

2.4.2.2 C
 ontraction monitoring frequency and duration

The frequency, duration, and intensity of contractions are monitored to assess

labor progress. Regular, strong contractions that increase in frequency and duration
indicate active labor [21].

2.4.2.3 F
 etal descent station

This measures the position of the baby’s head about the mother’s pelvis, ranging
from −3 (high in the pelvis) to +3 (crowning). A positive station indicates the baby is
moving down the birth canal [22].

2.4.2.4 V
 aginal examinations

Manual checks: Midwives perform vaginal examinations to assess cervical dila-

tion, effacement, and the baby’s position. These checks are crucial for determining
the stage of labor [23].

2.4.2.5 U
 se of partogram

Graphical tool: A partogram is a chart used to plot the progress of labor, including
cervical dilation, fetal heart rate, and contraction patterns. It helps in identifying any
deviations from the normal labor progression [24].

2.4.2.6 Ultrasound and sonographic assessment

Imaging techniques: Ultrasound can be used to assess fetal position, amniotic fluid
levels, and other factors that might affect labor progress. It provides a noninvasive
way to monitor labor [25].

2.4.2.7 M
 aternal vital signs

Monitoring health: Checking the mother’s blood pressure, pulse, and tempera-
ture helps ensure her well-being during labor. Abnormal vital signs can indicate
­complications [1].
In general, the four Ps are important in checking the progress of labor, which
include four Ps (power, passenger, passage, and psyche).
Labor progress is determined by assessing the four following components, also
known as the four Ps:

1. Power: The term “power” pertains to the intensity of uterine contractions and
the maternal efforts to expel the fetus during the second stage of labor. This
aspect is evaluated through abdominal palpation. Contractions that contribute
to normal labor progression should exhibit regularity, frequency, a duration
exceeding 60 seconds, and facilitate cervical effacement.

2. Passenger: This pertains to the evaluation of the fetus, specifically regarding its
size, position, and attitude, which refers to the spatial relationship among the
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various fetal parts. Additionally, it is essential to be cognizant of any underlying

conditions that may raise concerns regarding the progress of the pregnancy [24].

3. Passage: The anatomy of the bony pelvis must be evaluated in conjunction with
soft tissue elements, including the existence of a distended bladder or rectum,
any occupying masses, or the presence of vaginal septa. The assessment of pelvic
adequacy can only be conducted during the process of labor.

4. Psyche: This analysis acknowledges the significance of the mother’s emotional state
during labor, which can influence the overall progression of the labor process. Key
factors to evaluate include the levels of stress and underlying anxiety experienced
by the mother, the presence of sufficient support from a birthing partner, and the
establishment of a welcoming and supportive environment for the woman [24].

In the Figure 1, the Friedman curve shows the progress of labor [26].

2.5 C
 heck and monitor fetal heart rate

Monitoring the fetal heart rate (FHR) during labor is crucial for assessing the
baby’s well-being and ensuring a safe delivery. Here are the key methods and their
importance [27].

1. Auscultation: This involves periodically listening to the fetal heartbeat using a

special stethoscope or a Doppler device. It helps detect any irregularities in the
heart rate that might indicate fetal distress [28].

Figure 1.
Friedman curve diagram.
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2. Electronic fetal monitoring (EFM): EFM uses external or internal devices to

continuously record the fetal heart rate and uterine contractions.

• External monitoring: Involves placing two belts around the mother’s abdomen.
One belt uses Doppler ultrasound to detect the fetal heart rate, while the other
measures contractions.

• Internal monitoring: Involves inserting a small electrode through the cervix

and attaching it to the baby’s scalp to directly measure the heart rate. Provides
a continuous record of the fetal heart rate, allowing for real-time assessment
and immediate intervention if needed [29].

2.6 M
 other’s emotional needs

Addressing the emotional needs of mothers during labor is crucial for a positive
childbirth experience. Here are some key aspects to consider:

1. Emotional support

• Continuous presence: Having a continuous support person, such as a partner,

doula, or nurse, can significantly reduce anxiety and stress. Continuous
support has been shown to improve birth outcomes and increase maternal
satisfaction [30].

• Encouragement and reassurance: Providing words of encouragement and reas-

surance helps mothers feel more confident and in control during labor [31].

2. Respect and dignity

• Respectful care: Ensuring that the mother is treated with respect and dignity
throughout labor is essential. This includes maintaining her privacy, obtaining
informed consent, and respecting her birth plan [32].

• Cultural sensitivity: Being aware of and respecting cultural practices and

preferences can help mothers feel more comfortable and supported [32].

3. Information and communication

• Clear communication: Keeping the mother informed about the progress of labor
and any procedures being performed helps reduce fear and uncertainty [33].

• Informed decision-making: Encouraging the mother to ask questions and

participate in decision-making empowers her and enhances her sense of
control [34].

4. Physical comfort

• Comfort measures: Providing physical comfort measures, such as pillows,

warm blankets, and a comfortable environment, can help mothers feel more
at ease.
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• Mobility and positioning: Allowing the mother to move around and choose
comfortable positions during labor can help reduce discomfort and improve
labor progress.

5. Psychological support

• Addressing fears and anxieties: Acknowledging and addressing any fears or

anxieties the mother may have about labor and childbirth is crucial for her
emotional well-being.

• Positive birth environment: Creating a calm and supportive birth environment

can help reduce stress and promote a positive birth experience [31].

Meeting the emotional needs of mothers during labor is essential for a positive and
empowering childbirth experience. Providing continuous support, respectful care,
effective pain management, clear communication, physical comfort, and psychologi-
cal support can significantly enhance the overall experience for both the mother and
the baby.

3. The second stage of labor

The second stage of labor begins when the cervix is fully dilated to 10 centimeters
and ends with the birth of the baby. This stage is crucial as it involves the actual
delivery of the baby through the birth canal [35].

3.1 I mportance of the second stage of labor

1. Transition to birth: This stage marks the transition from labor to the birth of the
baby. It is characterized by strong and regular contractions that help push the
baby down the birth canal [36].

2. Maternal and neonatal outcomes: Proper management of this stage is vital for
minimizing maternal and neonatal morbidity and mortality. A prolonged second
stage can increase the risk of complications such as fetal distress and maternal
exhaustion [37].

3. Physiological changes: The mother experiences significant physiological changes,

including increased pressure on the rectum and the urge to push. These changes
are essential for the successful delivery of the baby [38].

3.2 Care during the second stage of labor

1. Monitoring: Continuous monitoring of the fetal heart rate and maternal vital
signs is crucial to ensuring the well-being of both mother and baby. This helps in
early detection of any signs of distress [39].

2. Support and guidance: Providing emotional and physical support to the mother
is essential. Encouraging words, helping with breathing techniques, and offering
comfort measures such as changing positions can make a significant difference [40].
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Labor and Delivery from a Public Health Perspective

3. Pushing techniques: Guiding the mother with effective pushing techniques can
help shorten the duration of the second stage and reduce the risk of complica-
tions. It is important to follow the mother’s cues and allow her to push when she
feels the urge [41].

4. Pain management: Pain relief options, such as epidurals or other analgesics,

should be discussed and provided as per the mother’s preference and medical
advice [17].

5. Preventing perineal trauma: Measures to prevent perineal trauma, such as con-

trolled pushing and the use of warm compresses, can help reduce the risk of tears
and the need for episiotomy [42].

3.3 Complications in the second stage of labor

1. Prolonged labor: This occurs when the second stage of labor lasts longer than
expected. Prolonged labor can increase the risk of maternal and fetal complica-
tions, including infection, postpartum hemorrhage, and the need for assisted
delivery or cesarean section [43].

2. Fetal distress: This is a condition where the fetus does not receive adequate
oxygen during labor, leading to abnormal heart rate patterns. Fetal distress can
necessitate immediate interventions such as an emergency cesarean section [44].

3. Shoulder dystocia: This is a rare but serious complication where the baby’s shoul-
der gets stuck behind the mother’s pelvic bone after the head has been delivered.
It requires prompt and skilled management to prevent injury to both the mother
and baby [45].

4. Perineal trauma: Tears or lacerations to the perineum (the area between the va-
gina and the anus) are common during the second stage of labor. Severe tears can
lead to significant pain, bleeding, and long-term complications such as inconti-
nence [42].

5. Uterine rupture: Although rare, uterine rupture is a life-threatening complica-

tion where the uterine wall tears during labor. It is more common in women with
a previous cesarean section or uterine surgery [46].

6. Maternal exhaustion: Prolonged pushing and labor can lead to significant physi-
cal and emotional exhaustion for the mother, impacting her ability to effectively
participate in the delivery process [47].

In summary, the second stage of labor is a critical phase that requires careful man-
agement and support to ensure a safe and positive birth experience for both mother
and baby. Midwifery support is crucial during the second stage of labor, as it can
significantly impact the mother’s experience and the outcome of the birth. Midwives
provide both physical and emotional support, helping to ensure a safe and positive
birthing experience [18].

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4. The third stage of labor

The third stage of labor begins immediately after the birth of the baby and ends
with the delivery of the placenta. This stage is crucial for ensuring the health and
safety of both the mother and the newborn [1].

4.1 I mportance of the third stage of labor

1. Placental separation and delivery: The primary event in this stage is the separa-
tion and expulsion of the placenta from the uterine wall. Proper management
is essential to prevent complications such as retained placenta and excessive
­bleeding [48].

2. Prevention of postpartum hemorrhage: This stage is critical for preventing post-

partum hemorrhage (PPH), which is a leading cause of maternal morbidity and
mortality worldwide. Effective management can significantly reduce the risk of
severe blood loss [49].

3. Uterine contraction: After the placenta is delivered, the uterus must contract to
close off blood vessels and prevent hemorrhage. Ensuring strong uterine con-
tractions is vital for minimizing blood loss [48].

4.2 Care during the third stage of labor

1. Active management: Active management of the third stage of labor (AMTSL) in-
volves administering a uterotonic drug (usually oxytocin) immediately after the
birth of the baby to stimulate uterine contractions and reduce the risk of PPH.
This approach has been shown to decrease the incidence of severe hemorrhage
and the need for blood transfusions [50].

The important causes of postpartum bleeding can be summarized as four (T) [1]:

• Tonicity (uterine atony after childbirth due to various causes such as long
induction of labor, maternal obesity, and multiparity)

• Trauma (caused by rupture of the uterus and genital tract)

• Tissue (remaining placenta inside the uterus)

• Thrombophilia (caused by disorders of blood coagulation factors)

2. Monitoring and assessment: Continuous monitoring of the mother’s vital signs

and blood loss is essential. Healthcare providers should assess the placenta to en-
sure it is complete and check for any signs of retained placental fragments [51].

3. Cord clamping: Delayed cord clamping (waiting 1–3 minutes after birth) is rec-
ommended to improve neonatal outcomes, including increased iron stores and
reduced risk of anemia in the infant [1].

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Labor and Delivery from a Public Health Perspective

4. Perineal care: If an episiotomy was performed or if there were any perineal

tears, they should be repaired promptly to prevent infection and promote
­healing [52].

5. Emotional support: Providing emotional support and reassurance to the

mother during this stage is important. The birth of the baby can be overwhelm-
ing, and ensuring the mother feels supported can enhance her overall birth
­experience [53].

In summary, the third stage of labor is a critical period that requires careful
management to ensure the health and safety of both the mother and the newborn.
Active management, continuous monitoring, and providing emotional support are
key components of care during this stage.

5. F
 our stages of labor

The fourth stage of labor, also known as the recovery stage, begins immediately
after the delivery of the placenta and lasts for about two hours. This stage is crucial
for monitoring the mother and ensuring that both she and the newborn are stable and
healthy.

5.1 I mportance of the fourth stage of labor

1. Monitoring for complications: This stage is critical for identifying and manag-
ing any immediate postpartum complications, such as postpartum hemorrhage,
uterine atony, or retained placental fragments [54].

2. Uterine contraction: Ensuring that the uterus continues to contract is essential to

prevent excessive bleeding. Uterine contractions help compress blood vessels and
reduce the risk of hemorrhage [48].

3. Maternal and neonatal bonding: The fourth stage provides an opportunity for
skin-to-skin contact between the mother and the newborn, which promotes
bonding, stabilizes the baby’s temperature, and encourages breastfeeding [55].

4. Assessment of vital signs: Continuous monitoring of the mother’s vital signs,

including blood pressure, pulse, and temperature, is important to detect any
signs of distress or complications [56].

5.2 C
 are during the fourth stage of labor

1. Monitoring and assessment: Healthcare providers should closely monitor the

mother’s vital signs and uterine contractions. They should also assess the amount
of vaginal bleeding and ensure that the uterus is firm and contracted.

2. Pain management: Providing appropriate pain relief is important to ensure

the mother’s comfort. This may include medications or nonpharmacological
­methods such as ice packs or warm compresses.
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3. Emotional support: Offering emotional support and reassurance to the mother

is crucial during this stage. The birth experience can be overwhelming, and
providing a calm and supportive environment can help the mother feel more at
ease [56].

4. Breastfeeding support: Encouraging and assisting the mother with breastfeeding

during the fourth stage can help establish successful breastfeeding and promote
the release of oxytocin, which aids in uterine contraction [57].

5. Perineal care: If the mother experiences any perineal tears or had an episiotomy,
proper care and assessment of the perineal area are necessary to prevent infec-
tion and promote healing [58].

In summary, the fourth stage of labor is a critical period that requires careful
monitoring and support to ensure the health and well-being of both the mother and
the newborn. Effective management during this stage can help prevent complications
and promote a positive postpartum experience.

6. Conclusion

The process of labor is divided into four distinct stages, each with its signifi-
cance and required care to ensure the health and safety of both the mother and the
newborn.

• First stage of labor: This stage involves the onset of labor and the dilation of the
cervix. Proper monitoring and support during this stage are crucial for managing
pain and ensuring the progress of labor.

• Second stage of labor: This stage begins with full cervical dilation and ends with
the birth of the baby. Effective pushing techniques, continuous monitoring,
and emotional support are essential to facilitate a safe delivery and minimize
complications.

• Third stage of labor: This stage involves the delivery of the placenta. Active
management, including the administration of uterotonic drugs, is important
to prevent postpartum hemorrhage and ensure the complete expulsion of the
placenta.

• Fourth stage of labor: Also known as the recovery stage, this period focuses on
monitoring the mother and newborn for any immediate postpartum complica-
tions. Providing emotional support, pain management, and assistance with
breastfeeding are key components of care during this stage.

Each stage of labor requires specific care and attention to ensure a positive and
safe birthing experience. Continuous monitoring, effective pain management, and
emotional support are critical throughout the entire process. By understanding
and addressing the unique needs of each stage, healthcare providers can help mothers
navigate labor with confidence and achieve the best possible outcomes for themselves
and their babies.
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Acknowledgements

I am very grateful to my dear husband (Rasoul Gurbanzadeh) and my children

(Aysu and Araz) who accompanied me on this great and arduous journey of science.
The author acknowledges the use of Grammarly AI tool for language polishing of the
manuscript.

Conflict of interest

The author declares no conflict of interest.

Author details

Fatemeh Ahadi Yulghunlu

Faculty of Nursing and Midwifery, Department of Midwifery, Tabriz University of
Medical Sciences, Tabriz, Iran

*Address all correspondence to: fatemehahadi8@gmail.com

© 2025 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
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