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.
Women aged 18-50 years
Scheduled for elective or non-emergency cesarean section at ≥37 weeks
Able to communicate in Mandarin and provide written informed consent
Expected hospital stay ≥24 h
Severe psychiatric disorders (schizophrenia, bipolar disorder, active suicidal ideation)
Maternal or neonatal need for ICU/NICU admission
Emergency cesarean section preventing baseline assessment
Communication or cognitive impairment precluding interview
Parallel
4-step narrative nursing program
BehavioralFour nurse-led storytelling sessions (pre-operative externalization, post-operative deconstruction, pre-discharge reconstruction, and 2-week meaning-reconstruction phone call) aimed at reducing anxiety and increasing breastfeeding self-efficacy.
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.
Postpartum depression risk
Proportion of women with Edinburgh Postnatal Depression Scale (EPDS) ≥ 10 at 48 hours, 2 weeks and 3 months.
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.
Pain intensity
Mean Numerical Rating Scale (NRS, 0-10) for self-reported pain at 48 hours and 2 weeks.
Breastfeeding continuation rate
Percentage of women who report any breastfeeding at 3 months.
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Xi Huang
Lead sponsor
Xiamen University
Sponsor institution
Xiamen University
Collaborator
Yilong People's Hospital
Collaborator
