The Effect of Mental Toughness Interventions During Birth on the Pelvic Floor in the Postpartum Period

This randomized controlled study was conducted to evaluate the effect of mental toughness interventions initiated during the third trimester of pregnancy and continued during childbirth on pelvic floor-related distress in the postpartum period. The mental toughness intervention consisted of breathing exercises, relaxation exercises, focusing/concentration, and imagery techniques.

During the third trimester of pregnancy, participants were randomly assigned to an intervention group or a control group using Randomizer.org. Participants in the intervention group received training on the mental toughness interventions. Two face-to-face follow-up sessions were conducted at 32-34 and 36-38 weeks of gestation. During these sessions, participants' understanding and ability to perform the interventions were assessed, their questions were answered, and additional practice training was provided when necessary. Participants in the control group did not receive the mental toughness interventions and continued to receive routine care until childbirth.

During labor, the mental toughness interventions were applied to participants in the intervention group at cervical dilations of 5-7 cm and 8-9 cm, for a total of two applications. Following each intervention, the mind-body index was assessed using the HeartMath device to objectively evaluate the participants' mind-body state during labor. Participants in the control group received routine intrapartum care, and their mind-body index was assessed using the HeartMath device at the same cervical dilation stages of 5-7 cm and 8-9 cm.

The interventions were designed to promote relaxation and reduce mental and physical tension during labor. The study examined whether relaxation and improved mind-body regulation during childbirth could contribute to reducing the additional physical and muscular load on the pelvic floor and consequently affect pelvic floor-related outcomes in the postpartum period.

Following randomization, baseline assessments included the Descriptive Information Form and the Pelvic Floor Distress Inventory-20 (PFDI-20). Within 48 hours after childbirth, the Birth and Postpartum Information Form was administered to participants in both groups. At 6 weeks postpartum, the PFDI-20 was administered again to assess pelvic floor-related distress.

• Mental Toughness (Behavioral): breathing exercises, relaxation techniques, focusing/concentration practices, and imagery

Primary outcomes

• Pelvic Floor Distress Inventory- 20 [At baseline (third trimester of pregnancy) and at 6 weeks postpartum.]: Assesses the presence and severity of pelvic floor distress symptoms, including urinary, colorectal-anal, and pelvic organ prolapse-related symptoms, using the Pelvic Floor Distress Inventory-20 (PFDI-20).

Secondary outcomes

• Mind-Body Index during Labor [At 5-7 cm and 8-9 cm cervical dilation during active labor.]: The Mind-Body Index was assessed using the HeartMath device to evaluate changes in mind-body coherence during labor. Measurements were obtained at two time points during active labor and compared between the intervention and control groups.

Sex: Female, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Being primiparous
* Being in the third trimester of pregnancy
* Having no communication barriers
* Being a pregnant woman with an expectation of vaginal delivery

Exclusion Criteria:

* Being multiparous
* Having a diagnosis of high-risk pregnancy
* Having a diagnosed pelvic floor dysfunction (Urinary Incontinence, Fecal Incontinence, or Pelvic Organ Prolapse)
* Being under 18 years of age
* Having a planned cesarean delivery

Study Discontinuation Criteria:

* Voluntary withdrawal from the study by the participant
* Emergency cesarean delivery decision
* Impairment of mental functions during the intrapartum or postpartum period

• Hüsniye Dinç Kaya, PhD, Principal investigator, Istanbul University - Cerrahpasa