Narrative Nursing for Cesarean Mothers' Anxiety and Breastfeeding Confidence

Xi Huang160 enrolled

Overview

This study tests whether a nurse-led "4-step narrative nursing" program can reduce anxiety and improve breastfeeding confidence in mothers who are having a planned or non-emergency cesarean section. What is the problem? About 30-40% of Chinese cesarean mothers feel high anxiety after surgery, and 1 in 5 is at risk for postpartum depression. Low confidence in breastfeeding is also common. What will we do? We will randomly assign 160 mothers (1:1) to either: Usual care - standard education and ward care, or Usual care plus narrative nursing - four short (10-20 min) conversations with a trained nurse: Before surgery - help the mother talk about her fears. 24-48 h after surgery - encourage her to "name" pain or worries and separate them from herself. Before discharge - guide her to find positive moments and build a "strong-mom" story. Two weeks later by phone - strengthen the new story and review feeding success. What will we measure? Main result: anxiety score at 48 h (STAI scale). Other results: depression risk, breastfeeding confidence, pain, and feeding rates up to 3 months. Possible benefits: Lower anxiety, better mood, higher breastfeeding rates. No drugs or extra procedures are involved, only talking. Risks: Minimal; some mothers may feel emotional during conversations, but nurses can pause or refer to counselling if needed.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

160

Conditions

Postpartum Anxiety

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 50 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. Women aged 18-50 years 2. Scheduled for elective or non-emergency cesarean section at ≥37 weeks 3. Able to communicate in Mandarin and provide written informed consent 4. Expected hospital stay ≥24 h 5. Singleton pregnancy with stable maternal and neonatal condition allowing routine mother-baby contact Exclusion Criteria: 1. Severe psychiatric disorders (schizophrenia, bipolar disorder, active suicidal ideation) 2. Maternal or neonatal need for ICU/NICU admission 3. Emergency cesarean section preventing baseline assessment 4. Communication or cognitive impairment precluding interview

Outcomes

Primary Outcomes

Postpartum anxiety at 48 hours

Mean score on the State-Trait Anxiety Inventory (STAI-State, 20 items) assessed 48 hours after cesarean delivery. Lower scores indicate less anxiety.

Time frame: 48 hours post-surgery

Secondary Outcomes

Postpartum depression risk

Proportion of women with Edinburgh Postnatal Depression Scale (EPDS) ≥ 10 at 48 hours, 2 weeks and 3 months.

Time frame: 48 hours, 2 weeks, 3 months postpartum

Breastfeeding self-efficacy

Mean score on the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF, 14 items) at 48 hours, 2 weeks and 3 months. Higher scores indicate greater confidence.

Time frame: 48 hours, 2 weeks, 3 months postpartum

Pain intensity

Mean Numerical Rating Scale (NRS, 0-10) for self-reported pain at 48 hours and 2 weeks.

Time frame: 48 hours and 2 weeks postpartum

Breastfeeding continuation rate

Percentage of women who report any breastfeeding at 3 months.

Time frame: 3 months postpartum