Association of a self-efficacy theory-driven doula program combined with stage-focused nursing with delivery outcomes: a retrospective study

Objective This retrospective observational study evaluated the association between a doula delivery program based on self-efficacy theory combined with stage-focused nursing and delivery outcomes (postpartum hemorrhage, perineal tears, and neonatal Apgar scores), labor duration, and labor pain. Secondary objectives included assessing associations with fear of childbirth, psychological state, resilience, childbirth self-efficacy, self-control, and childbirth experience. Methods This retrospective study analyzed clinical data from 98 parturients who underwent vaginal delivery at the hospital between January 2021 and December 2023. Parturients were divided into a comparison group ( n = 49, received stage-focused nursing only) and a study group ( n = 49, received a self-efficacy theory-based doula program combined with stage-focused nursing) based on the nursing protocol documented at admission, with non-randomized group allocation. Data on delivery outcomes, labor duration, pain intensity (visual analog scale, VAS), fear of childbirth (CAQ), psychological state (PANAS), psychological resilience (CDRISC-10), childbirth self-efficacy (CBSEI-C32), self-control (LAS), and childbirth experience (CEQ) were extracted from electronic medical records. Statistical analysis employed independent t -tests, chi-squared tests, and repeated-measures analysis of variance (ANOVA) as appropriate. Results The study group had a significantly shorter total labor duration (562.76 ± 34.85 vs. 608.59 ± 41.74 min, p < 0.001), lower labor pain score (VAS), higher neonatal Apgar score (9.26 ± 0.13 vs. 8.74 ± 0.18, p < 0.001), and improved psychological outcomes (CAQ, PANAS, and CDRISC-10). Conclusion In this retrospective study, the self-efficacy theory-based doula program combined with stage-focused nursing was associated with improved delivery outcomes, reduced pain, and enhanced psychological wellbeing. However, due to the observational design and potential selection bias, causal inferences cannot be drawn. These observed associations need to be confirmed through prospective randomized controlled trials.