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The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study

Year 2022, Volume: 12 Issue: 3, 730 - 738, 28.09.2022
https://doi.org/10.33808/clinexphealthsci.1016033

Abstract

Objective: To determine the effect of freedom of movement implemented in the dilatation stage, which is the first stage of labor, on the labor process in pregnant women who will give their first birth.

Methods: This study was designed as a randomized controlled trial. The study consisted of 70 primiparous women, including 35 in the study group (SG) and 35 in the control group (CG). Freedom of movement was provided to the study group in the first stage of labor. Data were collected using a Personal Information Questionnaire, a Labor Assessment Form, and the Visual Analog Scale (VAS) for perceived pain.

Results: The SG was observed to be walking when dilatations were 4-7 cm and mostly squatting when 8-10 cm (94.2%). The level of effacement, frequency of contraction, and descent of the fetal head were faster (p<0.01), and total dilatation, expulsion, placental expulsion, and total labor and delivery time were shorter in pregnant women in the SG (p<0.001). After delivery, the SG had shorter initial contact with their babies and first breastfeeding time, and the total 24-hour postpartum hemorrhage was less (p<0.001). When there was no freedom of movement during labor, the total dilation time (OR=2.41), expulsion time (OR=1.25), placental expulsion time (OR=1.16), total delivery time (OR=2.76), the VAS score at 6 – 7cm dilatation time (OR=2.48), and first breastfeeding time (OR=1.15) were found to increase (p<0.05-0.01).

Conclusion: The freedom of movement allowed at the first stage of labor was observed to reduce perceived labor pain, the process of labor and delivery time, the volume of postpartum hemorrhage, and the time of the first contact with the infant and the first breastfeeding.

Thanks

The authors express thanks to the pregnant women for participation in the study, and colleagues and the institution.

References

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  • [2] Moloney S, Gair S. Empathy and spiritual care in midwifery practice: Contributing to women’s enhanced birth experiences. Women and Birth. 2015; 28(4): 323–328. DOI:10.1016/j. wombi.2015.04.009
  • [3] Trainor L, Frickberg-Middleton E, McLemore M, Franck L. Mexican-Born women’s experiences of perinatal care in the united states. J Patient Exp. 2020; 7(6): 941-945. DOI: 10.1177/237.437.3520966818
  • [4] Okumuş F. Midwifery-led models of care for childbearing women: the Netherlands as an example. JACSD. 2016; 7: 120-141. DOI:10.17367/JACSD.201.672.1958. (Turkish)
  • [5] O’donovan A, Alcorn KL, Patrick JC, Creedy DK, Dawe S, Devilly GJ. Predicting posttraumatic stress disorder after childbirth. Midwifery. 2014; 30(8): 935-941. DOI: 10.1016/j. midw.2014.03.011
  • [6] Nilsson L, Thorsell T, Hertfeltwahn E, Ekström A. Factors influencing positive birth experiences of first-time mothers. Nurs Res Pract. 2013; 2013: 1-6. DOI:10.1155/2013/349124
  • [7] Bülbül G. How Birth Has Becomed a Medical Event?. Doğal Doğum.1. baskı. İstanbul: Hayy Kitap, 2016; p.41-59. (Turkish)
  • [8] Lothian JA. Safe, healthy birth: what every pregnant woman needs to know. J Perinat Educ. 2009; 18(3):48-54. DOI:10.1624/105812409X461225.
  • [9] Sayıner FD, Özerdoğan N. Natural labor. Maltepe University Journal of Nursing Science and Art, 2009; 2(3):143-148. (Turkish)
  • [10] Ondeck M. Healthy birth practice #2: walk, move around, and change positions throughout labor. J Perinat Educ. 2014; 23(4):188-93. DOI: 10.1891/1058-1243.23.4.188.
  • [11] Schiling T, Romano AM, DiFranco JT. Care Practice 2: Freedom of movement throughout labor, J Perinat Educ. 2007; 16(3), 21-24. DOI: 10.1624/105812407X217101.
  • [12] Karaman ÖE., Yıldız H. Freedom of Movement During Labor: How? What does it provide? What is the role of obstetrics and gynecologic nursing? Turkiye Klinikleri J Nurs Sci. 2018; 10(1):78-87. DOI: 10.5336/nurses.2017-57080 (Turkish)
  • [13] World Health Organization-WHO. Managing complications in pregnancy and childbirth: A Guide for Midwives and Doctors. Accessed [06 October 2021]. https://apps.who.int/iris/ handle/10665/255760
  • [14] World Health Organization-WHO Recomments for augmentation of labour. 5-26. Accessed [06 October 2021]. https://www.ncbi.nlm.nih.gov/books/NBK258875/pdf/ Bookshelf_NBK258875.pdf
  • [15] World Health Organization WHO recommendations: intrapartum care for a positive childbirth experience. Accessed [06 October 2021]. https://www.who.int/publications/i/ item/978.924.1550215
  • [16] Royal Collage Midwives-RCM (2010), Survey of positions used in labour and birth final report, 3-13. Accessed [06 October 2021]. https://docplayer.net/11994542-The-royal-college-of- midwives-survey-of-positions-used-in-labour-and-birth-final- report.html
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  • [18] Iravani M, Janghorbani M, Zarean E, Bahrami M. An overview of systematic reviews of normal labor and delivery management. Iran J Nurs Midwifery Res. 2015; 20(3):293-303. PMID: 26120327
  • [19] Simkin P, Ancheta R. Labor Progress Handbook, Translate in: Samiye Mete. İstanbul Tıp Bookstore, Third Edition, İstanbul. 2016.p. 277-324.
  • [20] Ergin AB, Kömürcü N. Pain management in labor: nonpharmacologic methods. KUHEAD. 2009; 6(2):29-35. (Turkish)
  • [21] ACOG-American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. (2014). Obstetric care consensus: safe prevention of the primary cesarean delivery. Obstetrics and Gynecology. Accessed [06 October 2021]. https://www.acog.org/clinical/clinical-guidance/obstetric- care-consensus/articles/2014/03/safe-prevention-of-the- primary-cesarean-delivery
  • [22] Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013; 8: CD003934. https://doi. org/10.1002/14651858. CD003934.pub4
  • [23] Rathfisch GY, Güngör İ. Evidence based practices in the management of first stage of labor. HEMARGE. 2009; 11(3):53-64. (Turkish)
  • [24] Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief Am Fam Physician. 2003; 68(6):1109-12. PMID:14524397
  • [25] Kadayıfçı O, Çetin-Coşar F. “Labor Positions”. Lamaze Philosophy Spiritual and Physical Preparation for Birth, 2013; 1. Baskı. İstanbul: Cross Basım ve Yayıncılık; p.174-7. (Turkish)
  • [26] Karaçam Z. The effect of positions for delivery to mother and baby health. Journal of Cumhuriyet University School of Nursing. 2001; 5(2):56-61. (Turkish)
  • [27] Jonge A, Teunissen DA, van Diem MT, Scheepers PL, Lagro- Janssen AL. Women’s positions during the second stage of labour: views of primary care midwives. J Adv Nurs. 2008; 63(4):347-356. DOI:10.1111/j.1365-2648.2008.04703.x
  • [28] Hofmeyr GJ. Evidence-based intrapartum care. Best Pract Res Clin Obstet Gynaecol. 2005; 19(1):103-115. DOI: 10.1016/j. bpobgyn.2004.10.009.
  • [29] ACOG American College of Obstetricians and Gynecologists, Approaches to limit intervention during labor and birth (2019). ACOG Committee Opinion No. 766. American College of Obstetricians and Gynecologists. Obstet Gynecol; 133: e164–73. Accessed [06 October 2021]. https://www. acog.org/clinical/clinical-guidance/committee-opinion/ articles/2019/02/approaches-to-limit-intervention-during- labor-and-birth
  • [30] Jonge PR, Johanson RB, Baxen P, Adrians VD, van der Westhuisen S, Jones PW. Randomised trial comparing the upright and supine positions for the second stage of labour. Br J Obstet Gynaecol. 1997; 104(5):567-571. DOI: 10.1111/ j.1471-0528.1997.tb11534.x
  • [31] Jonge A, Van Diem MT, Scheepers PL, Buitendijk SE, Lagro- Janssen AL. Risk of perineal damage is not a reason to discourage a sitting birthing position: a secondary analysis. Int J Clin Pract. 2010; 64(5):611-618. doi:10.1111/j.1742- 1241.2009.02316.x.
  • [32] Bodner-Adler B, Bodner K, Kimberger O, Lozanov P, Husslein P, Mayerhofer K. Women’s position during labour: influence on maternal and neonatal outcome. Wien Klin Wochenschr. 2003; 115(19-20):720-723.
  • [33] Thılagavaty G. Maternal birthing position and outcome of labor, J Fam Welf. 2012; 58(1): 68-73.
  • [34] Bomfim-Hyppólito S. Influence of the position of the mother at delivery over some maternal and neonatal outcomes. Int J Gynaecol Obstet. 1998; 63(1): 67-73. DOI:10.1016/s0020-7292(98)00186-6.
  • [35] Terry RR, Westcott J, O’shea L, Kelly F. Postpartum outcomes in supine delivery by physicians vs Nonsupine delivery by midwives, J Am Osteopath Assoc. 2006; 106:199-202.
  • [36] Miquelutti MA, Cecatti JG, Morais SS, Makuch MY. The vertical position during labor: Pain and satisfaction. RBSMI, 2009; 9(4): 393–398. https://doi.org/10.1590/ S1519.382.9200900.040.0002
  • [37] Mamede, Fabiana Villela, Almeida, Ana Maria de, Souza, Luiz de & Mamede, Marli Villela. Pain during the labor active phase: the effect of walking. Rev Lat Am Enfermagem. 2007; 15(6): 1157-1162. https://dx.doi.org/10.1590/ S0104.116.9200700.060.0016
  • [38] Molina FJ, Solá PA, López E, Pires C. Pain in the first stage of labor: relationship with the patient’s position. J Pain Symptom Manage. 1997; 13(2):98-103. DOI:10.1016/s0885-3924(96)00270-9.
  • [39] Nasir A, Korejo R, Noorani KJ. Childbirth in squatting position. J Pak Med Assoc. 2007; 57(1):19-22.
  • [40] Akın B, Soğukpınar N, Akman L, Yavuzşen HT. Evaluation The effects of maternal mobilization on mode of birth and newborn health status in the first stage of birth, Gümüşhane University Journal Of Health Sciences. 2017; 6(2): 33 – 41. (Turkish)
  • [41] Berghella V, Baxter JK, Chauhan SP. Evidence-based labor and delivery management. Am J Obstet Gynecol. 2008; 199(5):445-454. DOI: 10.1016/j.ajog.2008.06.093.
  • [42] Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst. 2017; Rev. 5, CD002006. https://doi. org/10.1002/14651858.CD002006.pub4.
  • [43] Souza JP, Miquelutti MA, Cecatti JG, Makuch MY. Maternal position during the first stage of labor: a systematic review. Reprod Health. 2006; 3(10):1-9. DOI:10.1186/1742-4755-3-10.
  • [44] Tatarlar A, Tokat MA. The effect of birth fear on lactation, infant sucking ability and first breastfeeding results. TAF Prev Med Bull, 2016; 15(2): 83-91. DOI: 10.5455/pmb.1-143.581.9087. (Turkish)
Year 2022, Volume: 12 Issue: 3, 730 - 738, 28.09.2022
https://doi.org/10.33808/clinexphealthsci.1016033

Abstract

References

  • [1] Ergin A, Mallı P. Aromatherapy in childbirth: a systematic review. KOU Sag Bil Derg. 2019; 5(2):72-80. DOI:10.30934/kusbed.496775. (Turkish)
  • [2] Moloney S, Gair S. Empathy and spiritual care in midwifery practice: Contributing to women’s enhanced birth experiences. Women and Birth. 2015; 28(4): 323–328. DOI:10.1016/j. wombi.2015.04.009
  • [3] Trainor L, Frickberg-Middleton E, McLemore M, Franck L. Mexican-Born women’s experiences of perinatal care in the united states. J Patient Exp. 2020; 7(6): 941-945. DOI: 10.1177/237.437.3520966818
  • [4] Okumuş F. Midwifery-led models of care for childbearing women: the Netherlands as an example. JACSD. 2016; 7: 120-141. DOI:10.17367/JACSD.201.672.1958. (Turkish)
  • [5] O’donovan A, Alcorn KL, Patrick JC, Creedy DK, Dawe S, Devilly GJ. Predicting posttraumatic stress disorder after childbirth. Midwifery. 2014; 30(8): 935-941. DOI: 10.1016/j. midw.2014.03.011
  • [6] Nilsson L, Thorsell T, Hertfeltwahn E, Ekström A. Factors influencing positive birth experiences of first-time mothers. Nurs Res Pract. 2013; 2013: 1-6. DOI:10.1155/2013/349124
  • [7] Bülbül G. How Birth Has Becomed a Medical Event?. Doğal Doğum.1. baskı. İstanbul: Hayy Kitap, 2016; p.41-59. (Turkish)
  • [8] Lothian JA. Safe, healthy birth: what every pregnant woman needs to know. J Perinat Educ. 2009; 18(3):48-54. DOI:10.1624/105812409X461225.
  • [9] Sayıner FD, Özerdoğan N. Natural labor. Maltepe University Journal of Nursing Science and Art, 2009; 2(3):143-148. (Turkish)
  • [10] Ondeck M. Healthy birth practice #2: walk, move around, and change positions throughout labor. J Perinat Educ. 2014; 23(4):188-93. DOI: 10.1891/1058-1243.23.4.188.
  • [11] Schiling T, Romano AM, DiFranco JT. Care Practice 2: Freedom of movement throughout labor, J Perinat Educ. 2007; 16(3), 21-24. DOI: 10.1624/105812407X217101.
  • [12] Karaman ÖE., Yıldız H. Freedom of Movement During Labor: How? What does it provide? What is the role of obstetrics and gynecologic nursing? Turkiye Klinikleri J Nurs Sci. 2018; 10(1):78-87. DOI: 10.5336/nurses.2017-57080 (Turkish)
  • [13] World Health Organization-WHO. Managing complications in pregnancy and childbirth: A Guide for Midwives and Doctors. Accessed [06 October 2021]. https://apps.who.int/iris/ handle/10665/255760
  • [14] World Health Organization-WHO Recomments for augmentation of labour. 5-26. Accessed [06 October 2021]. https://www.ncbi.nlm.nih.gov/books/NBK258875/pdf/ Bookshelf_NBK258875.pdf
  • [15] World Health Organization WHO recommendations: intrapartum care for a positive childbirth experience. Accessed [06 October 2021]. https://www.who.int/publications/i/ item/978.924.1550215
  • [16] Royal Collage Midwives-RCM (2010), Survey of positions used in labour and birth final report, 3-13. Accessed [06 October 2021]. https://docplayer.net/11994542-The-royal-college-of- midwives-survey-of-positions-used-in-labour-and-birth-final- report.html
  • [17] Royal Collage Midwives-RCM. Evidence based guidelenes for midwifery-led care in labour: positions for labour and birth, 3-5. Accessed [06 October 2021]. https://waterbirth.org/wp- content/uploads/2021/08/RCM-Guidelines_2012..pdf
  • [18] Iravani M, Janghorbani M, Zarean E, Bahrami M. An overview of systematic reviews of normal labor and delivery management. Iran J Nurs Midwifery Res. 2015; 20(3):293-303. PMID: 26120327
  • [19] Simkin P, Ancheta R. Labor Progress Handbook, Translate in: Samiye Mete. İstanbul Tıp Bookstore, Third Edition, İstanbul. 2016.p. 277-324.
  • [20] Ergin AB, Kömürcü N. Pain management in labor: nonpharmacologic methods. KUHEAD. 2009; 6(2):29-35. (Turkish)
  • [21] ACOG-American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. (2014). Obstetric care consensus: safe prevention of the primary cesarean delivery. Obstetrics and Gynecology. Accessed [06 October 2021]. https://www.acog.org/clinical/clinical-guidance/obstetric- care-consensus/articles/2014/03/safe-prevention-of-the- primary-cesarean-delivery
  • [22] Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013; 8: CD003934. https://doi. org/10.1002/14651858. CD003934.pub4
  • [23] Rathfisch GY, Güngör İ. Evidence based practices in the management of first stage of labor. HEMARGE. 2009; 11(3):53-64. (Turkish)
  • [24] Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief Am Fam Physician. 2003; 68(6):1109-12. PMID:14524397
  • [25] Kadayıfçı O, Çetin-Coşar F. “Labor Positions”. Lamaze Philosophy Spiritual and Physical Preparation for Birth, 2013; 1. Baskı. İstanbul: Cross Basım ve Yayıncılık; p.174-7. (Turkish)
  • [26] Karaçam Z. The effect of positions for delivery to mother and baby health. Journal of Cumhuriyet University School of Nursing. 2001; 5(2):56-61. (Turkish)
  • [27] Jonge A, Teunissen DA, van Diem MT, Scheepers PL, Lagro- Janssen AL. Women’s positions during the second stage of labour: views of primary care midwives. J Adv Nurs. 2008; 63(4):347-356. DOI:10.1111/j.1365-2648.2008.04703.x
  • [28] Hofmeyr GJ. Evidence-based intrapartum care. Best Pract Res Clin Obstet Gynaecol. 2005; 19(1):103-115. DOI: 10.1016/j. bpobgyn.2004.10.009.
  • [29] ACOG American College of Obstetricians and Gynecologists, Approaches to limit intervention during labor and birth (2019). ACOG Committee Opinion No. 766. American College of Obstetricians and Gynecologists. Obstet Gynecol; 133: e164–73. Accessed [06 October 2021]. https://www. acog.org/clinical/clinical-guidance/committee-opinion/ articles/2019/02/approaches-to-limit-intervention-during- labor-and-birth
  • [30] Jonge PR, Johanson RB, Baxen P, Adrians VD, van der Westhuisen S, Jones PW. Randomised trial comparing the upright and supine positions for the second stage of labour. Br J Obstet Gynaecol. 1997; 104(5):567-571. DOI: 10.1111/ j.1471-0528.1997.tb11534.x
  • [31] Jonge A, Van Diem MT, Scheepers PL, Buitendijk SE, Lagro- Janssen AL. Risk of perineal damage is not a reason to discourage a sitting birthing position: a secondary analysis. Int J Clin Pract. 2010; 64(5):611-618. doi:10.1111/j.1742- 1241.2009.02316.x.
  • [32] Bodner-Adler B, Bodner K, Kimberger O, Lozanov P, Husslein P, Mayerhofer K. Women’s position during labour: influence on maternal and neonatal outcome. Wien Klin Wochenschr. 2003; 115(19-20):720-723.
  • [33] Thılagavaty G. Maternal birthing position and outcome of labor, J Fam Welf. 2012; 58(1): 68-73.
  • [34] Bomfim-Hyppólito S. Influence of the position of the mother at delivery over some maternal and neonatal outcomes. Int J Gynaecol Obstet. 1998; 63(1): 67-73. DOI:10.1016/s0020-7292(98)00186-6.
  • [35] Terry RR, Westcott J, O’shea L, Kelly F. Postpartum outcomes in supine delivery by physicians vs Nonsupine delivery by midwives, J Am Osteopath Assoc. 2006; 106:199-202.
  • [36] Miquelutti MA, Cecatti JG, Morais SS, Makuch MY. The vertical position during labor: Pain and satisfaction. RBSMI, 2009; 9(4): 393–398. https://doi.org/10.1590/ S1519.382.9200900.040.0002
  • [37] Mamede, Fabiana Villela, Almeida, Ana Maria de, Souza, Luiz de & Mamede, Marli Villela. Pain during the labor active phase: the effect of walking. Rev Lat Am Enfermagem. 2007; 15(6): 1157-1162. https://dx.doi.org/10.1590/ S0104.116.9200700.060.0016
  • [38] Molina FJ, Solá PA, López E, Pires C. Pain in the first stage of labor: relationship with the patient’s position. J Pain Symptom Manage. 1997; 13(2):98-103. DOI:10.1016/s0885-3924(96)00270-9.
  • [39] Nasir A, Korejo R, Noorani KJ. Childbirth in squatting position. J Pak Med Assoc. 2007; 57(1):19-22.
  • [40] Akın B, Soğukpınar N, Akman L, Yavuzşen HT. Evaluation The effects of maternal mobilization on mode of birth and newborn health status in the first stage of birth, Gümüşhane University Journal Of Health Sciences. 2017; 6(2): 33 – 41. (Turkish)
  • [41] Berghella V, Baxter JK, Chauhan SP. Evidence-based labor and delivery management. Am J Obstet Gynecol. 2008; 199(5):445-454. DOI: 10.1016/j.ajog.2008.06.093.
  • [42] Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst. 2017; Rev. 5, CD002006. https://doi. org/10.1002/14651858.CD002006.pub4.
  • [43] Souza JP, Miquelutti MA, Cecatti JG, Makuch MY. Maternal position during the first stage of labor: a systematic review. Reprod Health. 2006; 3(10):1-9. DOI:10.1186/1742-4755-3-10.
  • [44] Tatarlar A, Tokat MA. The effect of birth fear on lactation, infant sucking ability and first breastfeeding results. TAF Prev Med Bull, 2016; 15(2): 83-91. DOI: 10.5455/pmb.1-143.581.9087. (Turkish)
There are 44 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Özen Esra Karaman 0000-0003-0978-5601

Hatice Yıldız 0000-0003-2026-0726

Publication Date September 28, 2022
Submission Date November 3, 2021
Published in Issue Year 2022 Volume: 12 Issue: 3

Cite

APA Karaman, Ö. E., & Yıldız, H. (2022). The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study. Clinical and Experimental Health Sciences, 12(3), 730-738. https://doi.org/10.33808/clinexphealthsci.1016033
AMA Karaman ÖE, Yıldız H. The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study. Clinical and Experimental Health Sciences. September 2022;12(3):730-738. doi:10.33808/clinexphealthsci.1016033
Chicago Karaman, Özen Esra, and Hatice Yıldız. “The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study”. Clinical and Experimental Health Sciences 12, no. 3 (September 2022): 730-38. https://doi.org/10.33808/clinexphealthsci.1016033.
EndNote Karaman ÖE, Yıldız H (September 1, 2022) The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study. Clinical and Experimental Health Sciences 12 3 730–738.
IEEE Ö. E. Karaman and H. Yıldız, “The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study”, Clinical and Experimental Health Sciences, vol. 12, no. 3, pp. 730–738, 2022, doi: 10.33808/clinexphealthsci.1016033.
ISNAD Karaman, Özen Esra - Yıldız, Hatice. “The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study”. Clinical and Experimental Health Sciences 12/3 (September 2022), 730-738. https://doi.org/10.33808/clinexphealthsci.1016033.
JAMA Karaman ÖE, Yıldız H. The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study. Clinical and Experimental Health Sciences. 2022;12:730–738.
MLA Karaman, Özen Esra and Hatice Yıldız. “The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study”. Clinical and Experimental Health Sciences, vol. 12, no. 3, 2022, pp. 730-8, doi:10.33808/clinexphealthsci.1016033.
Vancouver Karaman ÖE, Yıldız H. The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study. Clinical and Experimental Health Sciences. 2022;12(3):730-8.

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