Restricted accessResearch articleFirst published online 2026
The Effects of Midwife-Led Care on the Perception of Labor Pain,Labor Duration,Labor Comfort,and Respectful Maternity Care: A Single-Blind Randomized Controlled Trial
Continuous care provided by the same midwife throughout the maternity journey may have significant benefits for labor outcomes and women’s childbirth experiences. This single-blind randomized controlled trial, conducted in a public hospital in Türkiye between October 2024 and February 2025, investigated the effects of continuous midwifery care on labor pain, duration, comfort, and the perception of respectful maternity care. A total of 85 women were randomly assigned to either an intervention group (n = 43), receiving care from the same midwife during the prenatal, intrapartum, and postnatal periods, or a control group (n = 42), where care was provided by different midwives. Findings revealed that women in the intervention group experienced significantly lower pain during labor, shorter labor durations, and greater comfort. Additionally, their perceptions of respectful maternity care were markedly more positive than those in the control group (p < .001). These results suggest that continuity of midwifery care enhances both clinical and experiential outcomes for women. Implementing midwife-led continuity of care models in Türkiye could contribute to more personalized, comfortable, and respectful childbirth experiences, ultimately improving maternal satisfaction and well-being.
AkinB.Yurteri TurkmenH.Yalnız DilcenH.SertE. (2022). The effect of labor dance on traumatic childbirth perception and comfort: A randomized controlled study. Clinical Nursing Research, 31(6), 909–917. https://doi.org/10.1177/10547738211030745
2.
AltinayakS. Ö.OzkanH. (2024). Effect of warm and cold acupressure applied to the LI4 acupressure point on childbirth comfort during labor: A randomized controlled trial. Alternative Therapies in Health and Medicine, 30(1), 13–17.
3.
AsefaA. (2021). Unveiling respectful maternity care as a way to address global inequities in maternal health. BMJ Global Health, 6, e003559. https://doi.org/10.1136/bmjgh-2020-003559
4.
AthiraC.MajumdarA.SutarR. F.SinghB.ThampyP.RupaniA.DabarD. (2025). Exploring Respectful Maternity Care and its determinants: A mixed methods cross-sectional study from a rural area in central India. BMC Pregnancy and Childbirth, 25(1), Article 869.
5.
AttanasioL. B.Alarid-EscuderoF.KozhimannilK. B. (2020). Midwife-led care and obstetrician-led care for low-risk pregnancies: A cost comparison. Birth, 47(1), 57–66. https://doi.org/10.1111/birt.12464
6.
BostanogluG.BalM. D. (2021). The effects of continuous labor support by midwife: A randomized control trial. Clinical and Experimental Health Sciences, 11(2), 251–257.
7.
CankayaS.CanR. (2021). The effect of continuous supportive care on birth pain, birth fear, midwifery care perception, oxytocin use, and delivery time during the intrapartum period: An experimental study. Nigerian Journal of Clinical Practice, 24(11), 1624–1632. https://doi.org/10.4103/njcp.njcp_147_20
8.
CantorA. G.JungbauerR. M.SkellyA. C.HartE. L.JordaK.Davis-O’ReillyC.CaugheyA. B.TildenE. L. (2024). Respectful maternity care: A systematic review. Annals of Internal Medicine, 177(1), 50–64. https://doi.org/10.7326/M23-2676
9.
ChaisitsanguanK.KongvattananonP.SomprasertC. (2021). Strategies of comfort management during childbirth: A qualitative systematic review. Current Women’s Health Reviews, 17(1), 36–44.
10.
CombellickJ. L.TelferM. L.IbrahimB. B.NovickG.MorelliE. M.James-ConterelliS.KennedyH. P. (2023). Midwifery care during labor and birth in the United States. American Journal of Obstetrics and Gynecology, 228(2 Suppl.), S983–S993.
11.
de WolffM. G.LadekarlM.PaghN. B.OvergaardC. (2025). Women’s care satisfaction and birth experiences in a Danish urban university hospital: A comparative cross-sectional study on midwifery-led continuity of care and standard midwifery care models. Midwifery, 142, Article 104301. https://doi.org/10.1016/j.midw.2025.104301
12.
DişsizM.YılmazZ. D. K.DemirgözM. B.BayrıF. B.AşcıÖ. (2023). Development and psychometric properties of the Respectful Maternity Care Scale (RMCS). Journal of Reproductive and Infant Psychology, 43, 602–617. https://doi.org/10.1080/02646838.2023.2270690
13.
EvansK.PallottiP.SpibyH.EvansC.EldridgeJ. (2023). Supporting birth companions for women in labor: The views and experiences of birth companions, women and midwives: A mixed methods systematic review. Birth, 50(4), 689–710.
14.
FikreR.GubbelsJ.TeklesilasieW.GerardsS. (2023). Effectiveness of midwifery-led care on pregnancy outcomes in low-and middle-income countries: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 23(1), Article 386.
15.
ForsterD. A.McLachlanH. L.DaveyM. A.BiroM. A.FarrellT.GoldL.FloodM.ShafieiT.WaldenströmU. (2016). Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: Results from the COSMOS randomised controlled trial. BMC Pregnancy and Childbirth, 16, Article 28. https://doi.org/10.1186/s12884-016-0798-y
16.
GrenvikJ. M.RosenthalE.WeyS.SacconeG.De VivoV.De Prisco LcpA.Delgado GarcíaB. E.BerghellaV. (2022). Birthing ball for reducing labor pain: A systematic review and meta-analysis of randomized controlled trials. The Journal of Maternal-Fetal & Neonatal Medicine, 35(25), 5184–5193. https://doi.org/10.1080/14767058.2021.1875439
17.
GuoY.LoganH. L.GlueckD. H.MullerK. E. (2013). Selecting a sample size for studies with repeated measures. BMC Medical Research Methodology, 13(1), Article 100.
18.
HailemeskelS.AlemuK.ChristenssonK.TesfahunE.LindgrenH. (2022). Midwife-led continuity of care improved maternal and neonatal health outcomes in North Shoa Zone, Amhara Regional State, Ethiopia: A quasi-experimental study. Women and Birth, 35(4), 340–348. https://doi.org/10.1016/j.wombi.2021.08.008
19.
HajizadehK.VaeziM.MeedyaS.Mohammad Alizadeh CharandabiS.MirghafourvandM. (2020). Respectful maternity care and its relationship with childbirth experience in Iranian women: A prospective cohort study. BMC Pregnancy and Childbirth, 20, Article 468. https://doi.org/10.1186/s12884-020-03118-0
20.
HanahoeM. (2020). Midwifery-led care can lower caesarean section rates according to the Robson ten group classification system. European Journal of Midwifery, 4, Article 7. https://doi.org/10.18332/ejm/119164
21.
HeidariK.Amiri-FarahaniL.PezaroS. (2023). The relationship between attitude and self-efficacy of labor support with supportive behaviors from the perspective of midwives. BMC Nursing, 22, Article 36. https://doi.org/10.1186/s12912-023-01197-w
22.
HildingssonI.RubertssonC.KarlströmA.HainesH. (2019). A known midwife can make a difference for women with fear of childbirth—birth outcome and women’s experiences of intrapartum care. Sexual & Reproductive Healthcare, 21, 33–38. https://doi.org/10.1016/j.srhc.2019.06.004.
23.
IsmailI. A.AllamH.AliK. A. (2022). The effect of continuous support combined with breathing exercise on the progress of labor and intrapartum fatigue. Egyptian Journal of Health Care, 13, 1190–1205.
24.
LiuY.LiT.GuoN.JiangH.LiY.XuC.YaoX. (2021). Women’s experience and satisfaction with midwife-led maternity care: A cross-sectional survey in China. BMC Pregnancy and Childbirth, 21, Article 151. https://doi.org/10.1186/s12884-021-03638-3
25.
Loewenberg WeisbandY.KlebanoffM.GalloM. F.ShobenA.NorrisA. H. (2018). Birth outcomes of women using a midwife versus women using a physician for prenatal care. Journal of Midwifery & Women’s Health, 63(4), 399–409. https://doi.org/10.1111/jmwh.12750
26.
MiyauchiA.ShishidoE.HoriuchiS. (2022). Women’s experiences and perceptions of women-centered care and respectful care during facility-based childbirth: A meta-synthesis. Japan Journal of Nursing Science, 19, e12475. https://doi.org/10.1111/jjns.12475
27.
MutluS.OzkayaE. (2021). Evaluation of pregnancy, delivery, and postpartum effectiveness of maternity school trainings organized based on the guideline of Ministry of Health in Turkey: A comparative study. International Journal of Preventive Medicine, 12, Article 173. https://doi.org/10.4103/ijpvm.IJPVM_391_20
28.
ÖzcanE.AkdemirA. (2023). A developing paradigm in care: Respectful maternity care. Journal of Women’s Health Nursing (JOWHEN), 9(Special Issue 1), 56–61.
29.
PoturD. C.MerihY. D.KülekH.GürkanÖ. C. (2015). The validity and reliability of the Turkish version of the childbirth comfort questionnaire. Journal of Anatolia Nursing and Health Sciences, 18, 252–258.
30.
PriceD. D.McGrathP. A.RafiiA.BuckinghamB. (1983). The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 17(1), 45–56. https://doi.org/10.1016/0304-3959(83)90126-4
31.
RamasauskaiteD.NassarA.UbomA. E.NicholsonW., & FIGO Childbirth and Postpartum Hemorrhage Committee. (2023). FIGO good practice recommendations for cesarean delivery on maternal request: Challenges for medical staff and families. International Journal of Gynaecology and Obstetrics, 163(Suppl. 2), 10–20. https://doi.org/10.1002/ijgo.15118
SandallJ.SoltaniH.GatesS.ShennanA.DevaneD. (2016). Midwife-led continuity models versus other models of care for childbearing women. The Cochrane Database of Systematic Reviews, 4, Article CD004667. https://doi.org/10.1002/14651858.CD004667.pub5
34.
Santiváñez-AcostaR.Tapia-LópezE. L. N.SanteroM. (2020). Music therapy in pain and anxiety management during labor: A systematic review and meta-analysis. Medicina (Kaunas, Lithuania), 56(10), Article 526. https://doi.org/10.3390/medicina56100526
35.
SchuilingK. D.SampslelleC.KolcabaK. (2011). Exploring the presence of comfort within the context of childbirth. In BryarR.SinclairM. (Eds.), Theory for midwifery practice (2nd ed., pp. 197–212). Palgrave Macmillan.
36.
ShakibazadehE.NamadianM.BohrenM.VogelJ. P.RashidianA.NogueiraP. V.MadeiraS.LeathersichS.TunçalpÖ.OladapoO. T.SouzaJ. P.GülmezoğluA. M. (2018). Respectful care during childbirth in health facilities globally: A qualitative evidence synthesis. BJOG: An International Journal of Obstetrics & Gynaecology, 125(8), 932–942. https://doi.org/10.1111/1471-0528.15015
37.
ShiptonE. V.CallawayL.FoxcroftK.LeeN.de JerseyS. J. (2023). Midwife-led continuity of antenatal care and breastfeeding duration beyond postpartum hospital discharge: A systematic review. Journal of Human Lactation, 39(3), 427–440. https://doi.org/10.1177/08903344221126644
38.
SinghM.SinghA.GuptaJ. (2024). Exploring cesarean section delivery patterns in South India: A Bayesian multilevel and geospatial analysis of population-based cross-sectional data. BMC Public Health, 24, Article 2514. https://doi.org/10.1186/s12889-024-19984-8
39.
SmithV.GallagherL.CarrollM.HannonK.BegleyC. (2019). Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: An overview of systematic reviews. PLoS One, 14(1), e0224313. https://doi.org/10.1371/journal.pone.0224313
40.
SönmezT.ApayS. E. (2023). Woman-centered care in labor management: Choice, control, continuity. Anatolian Journal of Health Research, 4(2), 72–75.
41.
SosaG. A.CrozierK. E.StocklA. (2018). The experiences of midwives and women during intrapartum transfer from one-to-one midwife-led birth environments to obstetric-led units. Midwifery, 65, 43–50. https://doi.org/10.1016/j.midw.2018.07.001
42.
TandoğanÖ.OskayÜ. (2024). The effect of Rebozo technique on perceived labor pain and childbirth experience: A randomized controlled trial. Medicine, 103(35), e39346. https://doi.org/10.1097/MD.0000000000039346
43.
TürkmenH.ÇetinkayaS.KiliçH.TunaS. D.ŞirvanciM.MutluH. (2024). The effect of ice massage applied to the SP6 point on labor pain, labor comfort, labor duration, and anxiety: A randomized clinical trial. Journal of Midwifery & Women’s Health, 69(4), 491–498.
44.
UlfaR. M. (2021). Effect of the use of birth balls on the reduction of pain and duration of labor during the first stage of active and second stage of labor in primigravida maternity. Science Midwifery, 9(2), 418–430.
45.
Van der PijlM. S.KasperinkM.HollanderM. H.VerhoevenC.KingmaE.de JongeA. (2021). Client-care provider interaction during labour and birth as experienced by women: Respect, communication, confidentiality, and autonomy. PLoS One, 16(2), e0246697.
46.
VisserG. H. A.Ayres-de-CamposD.BarneaE. R.de BernisL.Di RenzoG. C.VidarteM. F. E.LloydI.NassarA. H.NicholsonW.ShahP. K.StonesW.SunL.TheronG. B.WalaniS. (2018). FIGO position paper: How to stop the caesarean section epidemic. Lancet (London, England), 392(10155), 1286–1287. https://doi.org/10.1016/S0140-6736(18)32113-5
47.
VogelJ. P.BohrenM. A.TuncalpÖ.OladapoO. T.GulmezogluA. M. (2016). Promoting respect and preventing mistreatment during childbirth. BJOG: An International Journal of Obstetrics & Gynaecology, 123(5), 671–674. https://doi.org/10.1111/1471-0528
48.
WHO Session. (2023). Nonclinical intervention to reduce unnecessary caesarean section.
49.
WigertH.NilssonC.DenckerA.BegleyC.JangstenE.Sparud-LundinC.MollbergM.PatelH. (2020). Women’s experiences of fear of childbirth: A meta synthesis of qualitative studies. International Journal of Qualitative Studies on Health and Well-being, 15(1), Article 1704484. https://doi.org/10.1080/17482631.2019.1704484
ZinsserL. A.StollK.GrossM. M. (2016). Midwives’ attitudes towards supporting normal labour and birth—A cross-sectional study in South Germany. Midwifery, 39, 98–102. https://doi.org/10.1016/j.midw.2016.05.006
