The Development of a Safe Childbirth Preparation Model for Pregnant Women with Premature Labor

Abstract

Introduction The care of pregnant women with preterm labor requires thorough preparation to ensure safe childbirth. Hospitalized women with preterm labor often experience considerable stress and heightened anxiety regarding their own health and the well-being of the fetus. Therefore, establishing a clear and structured approach to childbirth preparation enables professional nurses to make accurate and timely nursing diagnoses, closely monitor changes in maternal condition, communicate effectively, and deliver comprehensive nursing interventions. Such systematic preparation contributes significantly to maternal safety from the time of hospital admission through delivery. 

Objectives The objectives of this study were: 1) to describe the current situation of childbirth preparation among pregnant women with preterm labor; 2) to develop a model of safe childbirth preparation for women with preterm labor; and 3) to evaluate the outcomes of implementing this safe childbirth preparation model among women with preterm labor in the delivery room at Chonburi Hospital.

Design This study employed a research and development design. The researcher applied the concept of case management and the Plan–Do–Check–Act (PDCA) cycle.

Methodology The study was conducted in three phases. Phase 1 involved describing the situation of safe childbirth preparation among pregnant women with preterm labor at Chonburi Hospital. This phase included a review of medical records of women with preterm labor and focus group discussions. The discussions were divided into two groups: healthcare team (n = 6), consisting of one obstetrician, four professional nurses, and one practical nurse; and postpartum mothers with a history of preterm labor (n = 5). Phase 2 focused on developing a model of safe childbirth preparation for women with preterm labor. Phase 3 examined the outcomes of implementing this model. The study sample comprised 17 professional nurses working in the delivery room at Chonburi Hospital and 50 pregnant women with preterm labor admitted to the delivery room, selected purposively. Sample size was determined using the n4Studies program, and participants were purposively assigned into experimental and control groups (25 per group). Data collection instruments included guidelines for focus group discussions with healthcare team and postpartum mothers with a history of preterm labor, a questionnaire for the model possibility, and an anxiety scale for pregnant women. All instruments were validated for content validity by experts, yielding a content validity index (CVI) of 1.00. Reliability testing using Cronbach’s alpha coefficients demonstrated high internal consistency at .95 for the anxiety scale, .87 for the questionnaire on model possibility, and .74 for the nurse satisfaction scale. Data collection was conducted between December 2024 and May 2025. Data were analyzed using descriptive statistics, Independent t-test, Paired t-test, and Chi-square test.

Results The safe childbirth preparation model for pregnant women with preterm labor developed in this study comprised six key components: 1) assessment of maternal needs across physical, psychological, emotional, social, and spiritual dimensions; 2) evaluation of maternal condition and problem analysis, followed by case management planning with caregiver participation in decision-making, guided by clear information and practice protocols; 3) goal setting and implementation to achieve the defined objectives effectively; 4) collaborative planning with a multidisciplinary team to promote shared responsibility in maternal care; 5) monitoring of maternal self-care practices to ensure appropriateness and accuracy; and 6) outcome evaluation at delivery, including monitoring of gestational age and neonatal safety. Following implementation, results indicated that pregnant women with preterm labor in the experimental group demonstrated significantly lower anxiety levels (M = 16.84, SD = 3.44) compared to their pre-intervention scores (M = 24.20, SD = 4.66) and to the control group (M = 20.44, SD = 1.92) (t = 7.553, p < .001; t = 4.575, p < .001, respectively). The rate of full-term delivery in the experimental group was significantly higher than in the control group (χ² = 4.504, p = .034). However, the incidence of complications, such as palpitation/tachycardia and birth asphyxia, did not differ between groups. Professional nurses adhered to the model and reported satisfaction levels exceeding the target benchmark of 80%, with statistical significance (p < .001).

Recommendation The safe childbirth preparation model developed for pregnant women with preterm labor proved effective in reducing maternal anxiety and promoting full-term delivery. It is recommended that this model be implemented in the care of women with preterm labor and that its outcomes be monitored.