1. Which choices below best reflect the problem statement for the

1. Which choices below best reflect the problem statement for
the instructor-assigned article?
Not only does labor pain have negative effects on pregnant
women and fetuses, women’s psychological and emotional
states have a great effect on levels of perceived pain.
There is a limited number of studies regarding labor dance.
This study was conducted to determine the effects of labor
dance on perceived labor pain, birth satisfaction, and neonatal
outcomes.
A labor dance that a pregnant woman performs with her partner
reduces perceived pain
and increases the woman’s satisfaction with birth.
2. Which of the choices below best reflects the purpose
statement for the instructor assigned article?
Not only does labor pain have negative effects on pregnant
women and fetuses, women’s psychological and emotional
states have a great effect on levels of perceived pain.
There is a limited number of studies regarding labor dance.
This study was conducted to determine the effects of labor
dance on perceived labor pain, birth satisfaction, and neonatal
outcomes.
reduces perceived pain
and increases the woman’s satisfaction with birth.
3. According to Grove & Gray (2019), which of the following
statements is important when considering the significance and
relevance of a study's problem and purpose?
Does it predict the non-significant findings anticipated in the
study?
Does it specifically influence nursing education in university
settings?

Does it identify the future research to be generated by the
study?
Does it promote theory testing or development?
Does it identify extraneous variables?
4. When considering the feasibility of a study's problem and
purpose, Grove & Gray (2019) suggest that several areas shoul d
be evaluated, including: researcher expertise, money
commitment, ethical considerations, and availability of subjects,
facilities, and equipment. Which of the following statements
accurately assesses the feasibility of this article?
(Select all that apply.)
Funding sources for the study were clearly identified in the
article.
The author's credentials to design and conduct research are
described.
Evidence of protection of the subjects' rights was mentioned in
this article.
100% of the eligible subjects contacted participated in the
study.
5. According to Grove & Gray (2019), which one of the
following is NOT a major purpose of the review of literature
(ROL):
Describing the current knowledge of the practice problem
Identifying gaps in the knowledge base of the practice problem
Explaining how the current study contributes to the knowledge
being built
To explain the reasons behind the selection of the statistics used
in the study.
6. Select two MAJOR topics covered in the review of literature
(ROL) from the list below:
This experimental and prospective study aims to evaluate the
effects of labor dance.
Labor pain has major effects on both mother and fetus.

Patients were excluded if they underwent cesarean section, had
induced labor, or received narcotic analgesics.
Emotional support by significant others enhances the effect of
pain control efforts.
7. Current knowledge in the review of literature (ROL) (all
information included before the "Methods") is considered to be
articles that are within 5 years of the publication date of the
article (count articles from 2015 to 2020). This is often assessed
by reviewing the citations that are used in the ROL and
counting the number that meet this criterion. Which number
below most closely reflects the number of current citations in
the ROL?
5
7
10
13
14
8. Which one of these statements best describes this study's
research framework?
The framework is based on the gate control theory of pain.
The framework is based on endorphin theory.
The framework is based on the humanis tic care model.
The framework is based on the biomedical care model.
The framework is not clearly described by the authors.
9. What are some of the key concepts in this study's theoretical
framework?
(Select all that apply)
Random sampling
Emotional support
Perceived pain
Pre-eclampsia
10. Which one of the statements below is an example of a

relational statement from the theoretical framework?
Subjects were eligible to be included if they had no pre-
eclampsia.
effects of labor dance.
The support provided by people whose company is desired by
pregnant women during the labor
process is the main factor that improves the effective use of
non-pharmacological methods.
The labor dance starts in the active labor phase of the first labor
stage and continues until the end of the first stage.
11. On page 311, the authors state that the first research
objective, question, or hypothesis was: "This experimental and
prospective study aims to evaluate the effects of labor dance,
which is applied during the active phase of labor, on perceived
labor pain, birth satisfaction, and neonatal outcomes."
This is best described as a
Research objective
Research question
Research hypothesis
None of the above
12. Which of these are considered to be MAJOR study variables
in this study?
Pregnant women
Dance duration
Cesarean section
Number of pregnancies
Apgar score
Perceived pain

13. What is the conceptual definition of the following study
variable: labor dance?
Labor dance is a method of body movement with a partner
combined with massage from the partner intended to mobilize
emotional support.
Participants who met the inclusion criteria and received training
with a spouse or partner were assigned to the DPSG group.
Labor dance that a pregnant woman performs with her partner
reduces perceived pain and increases the woman’s satisfaction
with birth.
Labor dance is measured by assignment to one of the labor
dance groups.
14. What is the operational definition (as defined in the methods
section) of the following study variable: perceived pain?
Women’s psychological and emotional states have a great effect
on perceived pain.
Pain was measured by visual analogue scale when cervical
dilation was 4 cm. and 9 cm.
reduces perceived pain.
Pharmacological and non-pharmacological methods are used to
cope with labor pain.
15. Which demographic variables were assessed by the author
for this study?
Age
Gender
Education
Occupation
Race
Religion
16. The authors describe this study as experimental. According

to the classification system in Grove and Gray (2019), which
phrase best describes the research design of this study?
Descriptive
Correlational
Quasi-experimental
Experimental
Predictive correlational
17. Which phrase best describes the time element of the
research design of this study?
Cross-sectional design
Longitudinal design
None of the above
18. Does the study include a treatment or intervention described
in the methods section?
The authors do not describe an intervention or treatment.
The authors mention an intervention or treatment but do not
describe the details.
The authors mention an intervention or treatment and describe
the details.
The visual analogue pain scale measurement at cervical dilation
4 cm. and 9 cm. can be considered an intervention or treatment.
19. Does the author specifically mention that any piloting was
done prior to conducting this study?
Yes
No
20. The authors indicate on page 311 of the article that the Ege
University Research Ethics Committee approved the study. This
indicates that there was ethical approval to conduct the
research. In addition, an informed consent would be provided to

each participant. Per Grove & Gray (2019), which of the
following would NOT be considered essential information for
informed consent?
A statement of the research purpose and any long-term goals of
the study
A copy of the abstract of the article that will be used in the
publishing journal.
An explanation of the procedures to be followed in the study
A complete list of references to be used in the study.
1. What sampling method or plan was used by the authors in
this study?
Simple random sampling
Convenience sampling
Cluster sampling
Network sampling
2. According to Grove & Gray (2019), what are the potential
biases of convenience sampling?
This is a strong probability sampling method with very little
potential for bias.
This method is used when an ordered list of all members of the
population are available, and provides a random but not equal
chance for inclusion in the study.
This method provides little opportunity to control for bias
because subjects are included in the study merely because they
happen to be in the right place at the right time.
This method is specific to the individuals who were recruited
and the information gained cannot be generalized to others who
don't share these types of experiences.

3. What was the final sample size reported by the authors for
this study?
187
160
87
57
44
4. Was a power analysis conducted? If so, which statement best
describes the results of the power analysis?
A power analysis showed that the ideal sample size was 160
A power analysis showed that the ideal sample size was 80
A post hoc power analysis showed that the power achieved in
the study was 0.99
No power analysis was reported by the authors
5. Which of these statements would be considered to be specific
inclusion criterion for the sample in the research article?
Cervical dilation was between 4-8 centimeters
Had a caesarean section
Able to read and write English
Between 20 and 40 years of age
6. Which of these statements would be considered to be
exclusion criterion specifically identified by the author for the
sample in the research article?
Cervical dilation was between 4-8 centimeters
Had a caesarean section
Able to read and write English
Between 20 and 40 years of age
7. What is the acceptance rate for this study? (Hint: see page
232 in your text)
160/187
87/187
57/187

Cannot be calculated
8. Which of the following would be accurate for the attrition
rate for this study?
160/187
87/187
57/187
28/187
9. What was the setting for this research study? Briefly describe
the setting and indicate whether it was appropriate for
conducting this study.
The setting for this study was a partially controlled setting and
was appropriate for this study's research design.
The setting for this study was a natural or field setting and was
appropriate for this study's research design.
The setting for this study was a highly controlled setting and
was appropriate for this study's research design.
The setting for this study was not well described by the authors
and therefore not appropriate for conducting this study.
10. Which ones of these questionnaires, scales, or physiologic
measures are used in this research study?
Apgar score
Childbirth Self Efficacy Scale
Visual Analogue Pain score
Oxygen saturation value
Complications of Childbirth Survey score
11. What was the operational definition for the variable
Satisfaction with the Baby?
Apgar score
A subscore of the Mackey Childbirth Satisfaction Rating Scale

Visual Analogue score
Cannot be determined
12. What steps did the authors take to assure treatment fidelity?
Participants were randomly assigned to treatment or control
groups
Participants and their spouses/partners were trained in labor
dance during prenatal teaching
All research personnel were trained in labor dance using
training videos
No steps were taken to assure treatment fidelity
13. What types of questionnaires or surveys were used in this
research study?
The authors developed the Mackey Childbirth Rating Scale
The authors developed their own questions to ask about
demographic information.
Interviews were reportedly used, but the authors do not explain
what was included in them.
The authors used previously developed questionnaires or
surveys.
This study did not use any questionnaires or surveys.
14. Were any physiological measurements collected from the
subjects for the purpose of this study?
Yes
No
15. Which of the following best describes the data collection
process used in this study?
Participants were contacted by phone by nurse researcher.

Participants were given the questionnaires on enrollment in the
study
Questionnaires / surveys were mailed to the prospective
returned in a self-addressed stamped envelope.
Data was collected by the researcher during labor
Participants were recruited from the pool of pregnant patients
admitted to the hospital during a specific period
16. Based on the study's data collection methods, If there were
more than one data collector, would an estimation of inter-rater
reliability be an important concept for the authors to report on
for this study?
yes, and the authors reported their efforts to achieve inter -rater
reliability.
yes, but the authors do not discuss any efforts to achieve inter -
rater reliability.
no, the issue of inter-rater reliability does not apply here.
17. What descriptive statistics are used in this study?
mean
median
frequencies
standard deviation
z-scores
percentage distributions
18. What inferential statistics were used to examine the data
obtained from the subjects?
Pearson correlations
Factor Analysis

t-Test
Kruskal-Wallis
Chi-Square
ANCOVA
ANOVA
Multiple linear regression equations
None of the above inferential statistics were used in this study.
19. What is the level of significance (alpha) set at for this
study?
.01 or 1%
.05 or 5%
.10 or 10%
an alpha level or level of significance chosen by the authors was
not specifically mentioned in the text of the article and cannot
be inferred.
20. There are several statistically significant findings in this
study. Which of these statements from the article would be
considered a significant and predicted results?
Newborns’ first minute oxygen saturation levels were 89 in the
experimental groups and 88 in the control group
The median ﬁrst minute Apgar score was found to be 9 in
DPSG, DPMG, and CG.
The median ﬁfth minute Apgar score was found to be 10 in
DPSG, 9 in DPMG, and 8 in CG.
All groups were found to be similar in number of pregnancies,
week of pregnancy, cervical dilatation at the time of
hospitalization, and the duration of the active phase
21. Which of these statements from the article would be
considered a non-significant result?
The median total labor dance durations were 48 and 56 minutes
in DPSG and DPMG, respectively.

Newborns’ first minute oxygen saturation levels were 89 in the
experimental groups (DPSG, DPMG) and 88 in the control
group.
The median fifth minute Apgar score was found to be 10 in
DPSG, 9 in DPMG, and 8 in CG.
The fifth minute oxygen saturation levels were 99 in the
experimental groups and 94 in the control group.
22. Which one of these statements from the article would be
considered clinically important?
The fifth minute oxygen saturation levels were 99 in the
experimental groups and 94 in the control group.
in DPSG and DPMG, respectively.
week of pregnancy, and cervical dilatation at the time of
hospitalization.
Abdolahian et al. (2014) reported a VAS score of 6.89 in the
experimental groups and 8.29 in the control group.
23. Which of the following statements are strengths of the
study? (Select all that apply.)
The sample was randomly selected.
The groups were randomly assigned.
The study was highly powered.
Oxygen saturation results in this study agreed with those
obtained in previous studies.
24. Which one of these statements would be considered a
statement regarding generalization of these results?
This study was conducted in a mother-friendly hospital that
allows spouses to be in the delivery room.
The satisfaction status of women who received care under the
leadership of midwives was found to be high compared to the

women in other groups.
Findings obtained in this study also reveal that labor dance
renders positive effects not only on newborn babies but also on
women giving birth.
These study results are compatible with the literature.
25. Which one of these statements from the article would be
considered a recommendation for future studies?
These study results are compatible with the literature.
It is suggested to conduct dance practices in a wider sampling
with other attendants a pregnant women would ask for.
This study was conducted in a mother-friendly hospital that
allows spouses to be in the delivery room.
The results of this study demonstrated that labor dance
positively affected labor pain, birth satisfaction, and neonatal
results.
Department of Business Administration
Organization Design and Development- MGT 404
Assignment 2
Marks:
Course Learning Outcomes:
· Describe the basic steps of the organizational development
process.
· Analyze the human, structural and strategic dimensions of the
organizational development.
Part 1
Please read the case study entitled as “Job Design at Pepperdine
University.” available in your textbook “Organization
Development & Change”, p.115, in the 10th edition by
Cummings, T and Worley, C and answer the following
questions:

1. Describe the culture of Pepperdine University within which
an individual job is enriched.
2. Explain why it is important for an individual job design to be
congruent with the larger organization design. Support your
answer using one example from the case.
Part 2
Please refer to Figure 5.2 in your textbook (comprehensive
model for diagnosing organizational system) and answer the
following questions based on your understanding:
3. Choose an example of a hypothetical organization and
explain the three key inputs (or environmental types) that affect
the way such organization could be designed.
4. Choose an example of a hypothetical job position and
describe each of its design components at the individual level.
Answers:
Part 1:
A.1
A.2
Part 2:
A.3
A.4
Explore 16 (2020) 310�317
Contents lists available at ScienceDirect

Explore
journal homepage: www.elsevier.com/locate/jsch
Research Letter
The effect of labor dance on perceived labor pain, birth
satisfaction, and
neonatal outcomes
Bihter Akin, MW, Assist. Prof., PhDa,*, Birsen Karaca Saydam,
RN, Assoc. Prof., PhDb
a Selcuk University, Faculty of Health Sciences, Midwifery
Department, Konya, Turkey
b Ege University, Faculty of Health Sciences, Midwifery
Department, Izmir, Turkey
A R T I C L E I N F O
* Corresponding author.
E-mail addresses: [email protected] (B. Akin),
[email protected] (B.K. Saydam).
https://doi.org/10.1016/j.explore.2020.05.017
1550-8307/© 2020 Elsevier Inc. All rights reserved.
A B S T R A C T
Objective: This research was conducted to determine the effects
of labor dance on perceived birth pain, birth
satisfaction, and neonatal outcomes.
Design: This is an experimental study. Data were collected
under three groups during the active phase of
labor: the dance practitioner midwife group (DPMG, comprising
40 pregnant women), the dance practitioner
spouse/partner group (DPSG, comprising 40 pregnant women)
and the control group (CG, comprising 80
pregnant women).
Setting: This study was conducted between 1 April 2017 and 31
October 2017 in Turkey.

Participants: This study was administered on pregnant women
volunteers with no risk during the active
phase of labor.
Interventions: During the active phase, pregnant women in
DPMG danced with the midwife; pregnant
women in DPSG, on the other hand, danced with their
spouses/partners throughout the active phase. When
vaginal dilatation reached 4 cm and 9 cm, labor pain was
measured by employing the visual analog scale
(VAS). In the postpartum phase, newborn babies’ first, fifth,
and tenth minute Apgar scores and oxygen satu-
ration levels were measured and registered. In the first hour
after delivery, the Mackey Birth Satisfaction
Scale was administered. CG, on the other hand, received only
the routine procedures offered in the hospital.
Findings: The mean scores of VAS 1 and VAS 2 in DPSG and
DPMG were lower than in CG. The fifth and tenth
minute Apgar scores and the first, fifth, and tenth minute
oxygen saturation levels of the newborns in the
experimental groups, as well as the level of birth satisfaction,
were significantly higher than in CG.
Key conclusions: The study showed a positive effect of labor
dancing on the labor process.
© 2020 Elsevier Inc. All rights reserved.
Keywords:
Dance
Birth (delivery)
Pain
Satisfaction
Neonatal results
1. Introduction
Labor is a significant process for both pregnant women and

their
newborns. Pregnant women experience different feelings, such
as
fear and pain, during labor. Not only does labor pain have
negative
effects on pregnant women and fetuses, women’s psychological
and
emotional states have a great effect on levels of perceived pain.
1-6
Therefore, midwives should closely monitor the medical
statuses of
pregnant women and fetuses, check women’s physical and
psycho-
logical states, and provide necessary assistance for coping with
pain.7
Pharmacological and non-pharmacological methods are used to
cope with labor pain. 8-15 Regional and systemic analgesics are
preferred
as pharmacological methods. 16-18 Of the non-pharmacological
methods
used, massage, hot and cold therapies, therapeutic touch,
breathing
techniques, hypnosis, and music are most commonly used.19,20
These
non-pharmacological methods, the analgesic effects of which
are
explained by gate control and endorphin theory, are all
comfortable
practices that are easy to use and reliable.21,22 The support
provided by
people whose company is desired by pregnant women during the
labor
process is the main factor that improves the effective use of
non-phar-

macological methods and provides feelings of self-control to
pregnant
women during the process.20
Another non-pharmacological method that provides massage and
mobility with the support of the spouse/partner is the labor
dance.23
The labor dance starts in the active labor phase of the first labor
stage
and continues until the end of the first stage to reduce pregnant
women’s pain and provide emotional support. The pregnant
women
can dance with someone they prefer (spouse/partner, mother,
mid-
wife, etc.) accompanied by light, calming music. The pregnant
woman puts her hands on the shoulders of her partner and sways
from left to right while the partner massages the pregnant
woman’s
sacral area.24 The aim is to increase the effectiveness of the
method
performed with the spouse/partner’s support, upright position,
and
massage, apart from the music and body movements, and to
provide
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B. Akin and B.K. Saydam / Explore 16 (2020) 310�317 311
emotional support to the pregnant woman. 25-27 A labor dance
that a
pregnant woman performs with her partner reduces perceived
pain
and increases the woman’s satisfaction with birth.25 Yet, there
is a
limited number of studies regarding labor dance.25 In this
study, the
effects of labor dance with a midwife and spouse/partner are
com-
pared differently from previous studies. This study is important
as it
is the first study comparing the effects of midwife and
spouse/partner
support for women in the process of labor. This study was
conducted
to determine the effects of labor dance on perceived labor pain,
birth
satisfaction, and neonatal outcomes.
2. Materials & Methods
2.1. Design
effects of labor dance, which is applied during the active phase
of
labor, on perceived labor pain, birth satisfaction, and neonatal
out-
comes. This study was conducted at Urla State Hospital, Izmir,
Tur-
key, which is affiliated with the Ministry of Health’s Public
Hospitals
Administration. The study population was taken out of all the

preg-
nant women who were admitted to the Urla State Hospital for
labor
between April 2017 and October 2017.
2.2. Participants
The study sample included 160 pregnant women who had the
fol-
lowing characteristics:
� Those who were admitted to the Ministry of Health Urla State
Hospital for labor
� Those whose cervical dilatation was between 4 and 8 cm
� Those who had received labor dance training by attending
prena-
tal training with their spouses/partners in the perinatal period
(Only DPSG).
� Those who met the inclusion criteria (volunteering, term
preg-
nancy (37-41 gestational weeks), single fetus, no pregnancy
com-
plications (oligohydramniosis and polihydramniosis, placenta
previa, pre-eclampsia, premature rupture of membrane, presen-
tation anomalies, intrauterine growth retardation, intrauterine
death, macrosomic baby, fetal distress, etc.).
We excluded patients if
� They underwent cesarean section
� Labor was inducted
� Narcotic analgesics were used
The dance practitioner spouse/partner group (DPSG) included

40
pregnant women who signed the informed consent form, the
dance
practitioner midwife group (DPMG) included 40 pregnant
women and
midwives who had received labor dance training, and the
control group
included 80 pregnant women who were subjected to routine
treatment
without dance. The sample size was determined using power
calcula-
tions G*Power 3, taking into account previous studies on labor
dance for
satisfaction. Estimates of effects were derived from the findings
of Abdo-
lahian et al. (2014), who reported on the mean satisfaction of a
experi-
mental group (4.66 § 0.66) and a control group (4.13 § 1.04).25
We
aimed at detecting a similar difference. The number of samples
in each
group (experimental and control) was 80. The power analysis
showed
that the study sample size had 99% power with a = .05.
2.3. Data collection tools
A visual analog scale (VAS) was administered to determine
preg-
nant women’s perceived labor pain when cervical dilatation was
4 cm, and the VAS was readministered when cervical dilatation
was
9 cm. Electronic fetal monitoring was performed, and fetal heart
rate
was examined and recorded on a partogram by a researcher
every

thirty minutes. The Mackey Childbirth Satisfaction Rating Scale
was
administered in the first hour after the delivery to determine
preg-
nant women’s satisfaction levels. Newborns’ first minute, fifth
min-
ute, and tenth minute Apgar scores were evaluated and
recorded.
Newborns’ first minute, fifth minute, and tenth minute oxygen
satu-
ration levels were measured on their right hands, and the results
were recorded. Only routine practices were performed with the
con-
trol group, and data were recorded as in the experimental groups
(Figure 1).
2.4. Data collection procedures and labor dance
The pregnant women and their spouses/partners were trained in
labor dance during prenatal training (for DPSG). In order not to
affect
the results the study, training was given about labor dance to
women
and their spouses/partners without giving any information about
the
aim of study and the effects of labor dance on labor pain. The
preg-
nant women and their spouses/partners who wanted to perform
the
practice were asked to inform the researcher when the labor
started.
The researcher stayed with the pregnant women and their
spouses
during the practice and labor process. The pregnant women
started
to dance with their spouses during the active phase of the labor
pro-

cess, accompanied by meditation music in a dim, otherwise
silent
environment. The spouse or partner massaged the pregnant
women’s
sacral areas while dancing. During the active phase of labor, the
preg-
nant women in DPMG danced with the midwives who were
atten-
dant in the delivery room and who were monitoring the pregnant
women’s statuses. Only routine practices were performed with
the
control group (electronic fetal monitoring was performed, and
fetal
heart rate was examined and recorded on a partogram by a
researcher every thirty minutes).
2.5. Analysis
Data analysis was conducted using the Statistical Package for
Social
Science 11.0. Descriptive data regarding pregnant women were
pro-
vided as numbers and percentage distributions. Chi-squared
tests
were used for categorized/classified variables. The Shapiro-
Wilk test
was employed to determine certain obstetrical traits of pregnant
women, the total sum of dance time, perceived level of pain and
birth
satisfaction among mothers, and whether or not data revealed a
nor-
mal distribution prior to comparing the Apgar and oxyge n
saturation
levels of the newborns. Based on these test results, the Kruskal -
Wallis
test was administered to analyze abnormally distributed data.
Median,

minimum-maximum, mean, and standard deviation values are as
demonstrated. A post-hoc test was performed for further
analysis in
case of a difference between the groups after the Kruskal -Wallis
test.
Data were evaluated at a p < 0.05 threshold for statistical
significance.
2.6. Ethical considerations
Ethical approval for this study was obtained from the Ege
Univer-
sity Research Ethics Committee, reference 24.03.17/ 17-3/8.
Clinical
trials of the research were registered under the code
NCT04196660.
3. Results
The pregnant women’s mean ages were 26.32 § 4.76 years,
27.45 §
4.57 years, and 27.38 § 3.42 years in DPSG, DPMG, and CG,
respectively.
As shown in Table 1, DPSG, DMPG, and CG had no statistically
significant
differences in demographic features and were homogeneous.
Pregnant women that met research inclusion
criteria and volunteered to take part in the research
(N =187)
Midwife group practicing dance (n =
44)
Control group (n = 87)Spouse/partner group practicing

dance (n = 57)
Excluded from the research
(11 women that the researcher did not
attend during delivery, 3 women
giving birth in a different institute, 2
women who quit the research, 1
woman who underwent caesarean
delivery)
Excluded from the research (1 woman
who did not deliver by dancing with
the midwife, 3 women who
underwent caesarean delivery)
Excluded from the research (7)
Having caesarean delivery (3)
Women who quit the research (4)
Assignment of women who met the
inclusion criteria and agreed to
perform labor dance with a midwife
in the dance practitioner midwife
group (DPMG)
inclusion criteria and did not want to
perform a labor dance
When cervical dilatation was 4 cm,
labor dance started with women’s
spouses/partners, with intermittent
dance during the labor process
When cervical dilatation was 4 cm,
labor dance started with women’s

midwives, with intermittent dance
during the labor process
Routine care was offered (cervical
dilatation and fetal heart rate was
examined and recorded)
VAS practice when cervical
dilatation was 4 cm (for all groups)
VAS practice when cervical
dilatation was 9 cm (for all groups)
In the postpartum phase, data were
collected about the newborns by
administering a birth satisfaction
scale in the first hour after birth (for
all groups).
Analyzed (n = 40) Analyzed (n = 40) Analyzed (n = 80)
inclusion criteria and received labor
dance training by attending prenatal
training in the dance practitioner
spouse/partner group (DPSG)
Figure 1. Practice Stages of the Research
312 B. Akin and B.K. Saydam / Explore 16 (2020) 310�317
Table 1
Distributions Based on Pregnant Women’s Age Groups and
Educational Statuses

Variables* GROUPS
Dance Practitioner Spouse/Partner Group Dance Practitioner
Midwife Group Control Group Total
n % n % n % n %
Age Group
< 20 Years Old 5 12.5 0 0 0 0 5 3.1
20-24 Years Old 10 25 12 30 24 30 46 28.8
25-29 Years Old 16 40 16 40 36 45 68 42.5
30-34 Years Old 9 22.5 10 25 20 25 39 24.4
> 35 Years Old 0 0 2 5 0 0 2 1.2
x2 = 1.228 p = 0.351
Educational Status
Literate/Primary School 2 5 4 10 4 5 10 6.3
Middle School 0 0 8 20 22 27.5 30 18.7
High School 22 55 17 42.5 37 46.3 76 47.5
University and above 16 40 11 27.5 17 21.3 44 27.5
x2 = 16.120 p = 0.013
Occupational Activity
Worker 4 10 8 20 14 17.5 26 16.25
Government Official 11 27.5 10 25 11 13.75 32 20
Self-employment 9 22.5 9 22.5 16 20 37 23.125
Housewife 16 40 13 32.5 39 48.75 65 40.625
x 2 = 6.425 p= 0.377
Smoking Status Before Pregnancy
Smoking 13 32.5 7 17.5 26 32.5 46 28.75
No smoking 27 67.5 33 82.5 54 67.5 114 71.25
x 2 = 3.295 p= 0.193
TOTAL 40 100.0 40 100.0 80 100.0 160 100.0
* Number and percentage distributions of the groups are
presented. Chi-Squared (p-value) methods were used for
categorized/classified data, respectively.

week of pregnancy, cervical dilatation at the time of
hospitalization,
and the duration of the active phase (Table 2).
in DPSG and DPMG, respectively. These two groups were
similar in
terms of total dance durations (p = 0.873). The median resting
times
were 113 and 132 minutes in DPSG and DPMG, respectively,
and
these two groups were similar in terms of resting times (p =
0.376)
(Table 3).
The mean scores of perceived pain between groups were evalu-
ated twice, when cervical dilatation was 4 cm and when cervical
dila-
tation was 9 cm (Table 4). The difference in the pain scores
when
cervical dilatation was 4 cm was found to be significant (p =
0.043).
When cervical dilatation was 9 cm, the difference was measured
with respect to perceived labor pain level between groups
(p = 0.014). In further analyses (by post hoc Tukey test) this
difference
was attributed to the significant lowness of DPSG and DPMG
pain lev-
els in contrast to CG (p = 0.01). The median first minute Apgar
score
was found to be 9 in DPSG, DPMG, and CG, and there was no
Table 2
Pregnant Women’s Distributions Based on the Number of

Pregnancies, Week of Pregn
Active Phase
Variables*
Dance Practitioner Spouse/Partner Group n = 40
Median (Min-Max) Mean§SD
Number of Pregnancies 1 (1-2) 1.47§0.50
x2 = 0.403 p = 0.817
Week of Pregnancy 40.0 (38-41) 39.52§0.87
x2 = 6.001 p = 0.050
Cervical Dilatation
at Hospitalization (cm)
2 (1-3) 2.32§0.61
x2 = 2.759 p = 0.252
Duration of Active Phase (hours) 5.5 (3-12) 6.77§2.64
x2 = 0.905 p = 0.636
* The Kruskal-Wallis H (x2 value) method was used and is
shown as the median
deviation.
statistically significant difference between the groups (p =
0.91). The
median fifth minute Apgar score was found to be 10 in DPSG, 9
in
DPMG, and 8 in CG, and this difference was statistically
significant (p
< 0.01). Further analysis (by post hoc Tukey test) found that
this dif-
ference arose from the significantly higher Apgar scores of
DPSG
compared to those of DPMG and CG. The median tenth minute

Apgar
score was found to be 10 in DPSG, DPMG, and CG (p = 0.06).
Newborns’ first minute oxygen saturation levels were 89 in the
experimental groups (DPSG, DPMG) and 88 in the control
group, and
there was a statistically significant difference between the
groups
(p = 0.05). The fifth minute oxygen saturation levels were 99 in
the
experimental groups and 94 in the control group, and the tenth
min-
ute oxygen saturation levels were 99 in the experimental groups
and
the control group. There was a statistically significant
difference in
the fifth minute and tenth minute oxygen saturation levels
between
the groups (p < 0.01) (Table 5).
In order to analyze the birth satisfaction of the mothers, the
Mackey Birth Satisfaction Scale was administered to compare
the
total mean scores and subdimensions of the scale. Among
DPSG,
ancy, Cervical Dilatation at the Time of Hospitalization, and the
Duration of the
GROUPS
Dance Practitioner Midwife Group n = 40 Control Group n = 80
Median (Min-Max) Mean§SD Median (Min-Max) Mean§SD
1 (1-4) 1.52§0.71 1 (1-4) 1.46§0.65
39.6 (38-41) 39.57§0.71 39.0 (37-41) 39.23§0.78

3 (1-4) 2.55§0.84 2 (1-4) 2.36§0.71
6.0 (3-12) 6.35§2.20 6.0 (3-20) 6.72§2.34
value with minimum and maximum values in parentheses and
mean, standard
Table 3
Findings Regarding the Total Dance and Resting Durations of
the Pregnant Women in the Experimental Groups
Variables* GROUPS
Dance Practitioner Spouse/Partner Group n = 40 Dance
Practitioner Midwife Group n = 40
Total Dance Duration (minutes) 48 (43-124) 63.30§24.33 56
(36-95) 60.68§20.22
z = -.159 p = 0.873
Total Rest Duration (minutes)** 113 (58-216) 140.96§57.52
132 (67-216) 143.01§22.44
z = -.886 p = 0.376
* The Mann-Whitney U Test (Z value) was performed.
** Resting time included activities such as sitting in bed, lying,
sleeping, eating, and showering, which the pregnant women per-
formed when they were not dancing.
Table 4
Pregnant Women’s Distributions of Perceived Pain Scores When
Cervical Dilatation Was 4 cm. and When Cervical Dilatation

Was 9 cm.
Variables GROUPS
Dance Practitioner Spouse/
Partner Group n = 40
Dance Practitioner
Midwife Group n = 40
Control Group n = 80 Statistical Value
Median (Min-Max) Mean§SD Median (Min- Max) Mean§SD
Median (Min-Max) Mean§SD P Value
When cervical dilatation was
4 cm (mm.)*
5.00 (3-7) a 5.02§1.14 5.00 (2-8)b 5.35§1.87 5.00 (3-8)c
5.61§1.34 0.043a<b,c***
When cervical dilatation was
9 cm(mm.)**
9.00 (7-10) a 8.60§1.03 9 (7-10)b 8.82§1.15 9.00 (8-10)c
9.17§0.44 0.014a,b <c
Since the data displayed a normal distribution according to the
Shapiro-Wilk test, the median, minimum, maximum values are
listed after the results of the Kruskal-
Wallis test.
* For DPSG and DPMG, labor dance not started yet
** For DPSG and DPMG, after labor dance
*** Post hoc Tukey test
Table 5
Comparison of Newborns’ Apgar Scores and Oxygen Saturation

Levels
Variables* GROUPS
Midwife Group Control Group Statistical Value
Median (Min-Max) Mean§SD P value
Apgar Scores
First Minute 9 (8-9) 8.70§0.46 9 (7-9) 8.65§0.57 9 (8-9)
8.66§0.47 0.91
Fifth Minute 10 (9-10) a 9.80§0.40 9 (8-10) b 9.42§0.59 8 (8-
10) c 9.21§0.41 <0.01a,b>c**
Tenth Minute 10 (9-10) 9.92§0.26 10 (9-10) 9.82§0.38 10 (9-
10) 9.75§0.43 0.06
Oxygen Saturation Levels
First Minute 89 (84-98) 88.85§3.07 89 (82-98) 88.95§2.80 88
(84-97) 87.72§2.33 0.05 a,b>c
Fifth Minute 99 (97-100) a 98.92§0.76 99 (92-99) b 97.25§2.67
94 (86-99) c 93.47§3.99 <0.01a,b>c
Tenth Minute 99 (99-100) a 99.50§0.50 99 (94-100) b
99.10§1.54 99 (92-100) c 97.70§2.70 <0.01a,b>c
* Since the data displayed a normal distribution according to
the Shapiro-Wilk test, the median, minimum, maximum values
are listed after the results of the
Kruskal-Wallis test.
** Post hoc Tukey test
DPMG, and CG, the subdimensions of satisfaction with the self,
the
baby, the midwife, the doctor, and the birth were respectively
found
to have a statistically significant difference from the total mean

score
of birth satisfaction (p < 0.01) (Table 6). In further analyses (by
post
hoc Tukey test) this difference was attributed to the result that
in the
experimental groups (DPMG and DPMG), the subdimension
values of
satisfaction with the self, the baby, the midwife, the doctor, and
the
birth were above the values measured in the control group at a
statis-
tically significant level (p < 0.05) (Table 6).
4. Discussion
In light of the findings obtained in this research, it was deter -
mined that labor dance positively impacted perceived labor pain
and
neonatal outcomes as measured by the newborns’ Apgar scores
and
oxygen saturation levels and the mothers’ birth satisfaction
levels.
Abdolahian et al. (2014) reported a VAS score of 6.89 in the
exper-
imental groups and 8.29 in the control group before the labor
dance
in a study conducted to determine the effects of labor dance on
birth
satisfaction and labor pain. Pregnant women’s pain levels were
re-
evaluated at the 30th, 60th, and 90th minutes of labor dance.
The per-
ceived pain levels were significantly lower in the experimental
groups compared to the control group.25 Erdogan et al. (2017),
in a

study that analyzed the effects of back-massage applied to
pregnant
women in the first phase of labor, drew a comparison between
VAS
scores at the latent, active, and transmission phases of labor.
Com-
pared to the control group, all of the VAS scores were measured
as
lower in the massage group.28 This study and previous studies
sug-
gest that pregnant women felt less pain and needed less
analgesic aid
when supportive care and non-pharmacological methods were
applied. There was no difference in terms of receiving care from
spouses or midwives.
A labor dance performed with a spouse may have positive
effects
on newborns’ fifth minute Apgar scores (Table 5). There was no
dif-
ference in newborns’ first minute Apgar scores between groups,
but
the fifth minute and tenth minute Apgar scores were a bit higher
in
DPSG, which means that the bond between the spouse/partner
and
the pregnant woman positively affects newborns. Methods that
were
Table 6
Comparison of Mothers’ Birth Satisfaction Sub-Scale and Mean
Scale Scores
Variables* GROUPS

Midwife Group Control Group Statistical Value
Median (Min-Max) Mean§SD x2 Value P Value
Self-Satisfaction, Total Score 45 (38-45) a 44.22§1.64 44 (39-
45) b 43.85§1.47 43 (33-45) c 41.10§4.13 34.136 <0.001
a>b,c**
Satisfaction with the Baby,
Total Score
15 (13-15) a 14.42§0.84 15 (12-15) b 14.35§0.80 13 (9-15) c
13.40§1.34 25.374 <0.001a,b>c
Satisfaction with the Midwife,
Total Score
45 (43-45) a 44.82§0.50 45 (41-45) b 44.60§1.21 45 (39-45) c
43.41§2.28 15.541 <0.001a,b>c
Satisfaction with the Physician,
Total Score
39 (35-40) a 38.77§0.91 40 (37-40) b 39.27§1.21 40 (32-40) c
38.56§2.37 19.008 <0.001a,b>c
Satisfaction with the Birth,
Total Score
15 (14-15) a 14.95§0.22 15 (13-15) b 14.87§0.40 15 (12-15) c
14.60§0.70 22.600 <0.001a,b>c
Total Mean Score of the Child-
birth Satisfaction Rating
Scale

159 (143-160) a 157.20§3.67 157 (151-160) b 157.07§2.84 156
(135-160) c 151.07§9.55 12.723 0.002a,b>c
* A Kruskal-Wallis Test was administered since the data
distribution was not normal.
** Post hoc Tukey tes
applied in previous studies, which included interventions for
reduc-
ing labor pain, had no negative effects on newborns’ Apgar
scores.
Regarding the implementation of the practice, no difference in
the
Apgar scores was present between the infants of the different
groups
of pregnant women.22,29 Lawrence et al. (2013) investigated
twelve
studies in a meta-analysis to examine the effects of maternal
mobili-
zation on labor and found only one study that demonstrated that
newborns’ fifth minute Apgar scores in the experimental groups
were higher than in the control group.9 Support, mobility, and
non-
pharmacological methods provided to women during labor
reduced
the anxiety of the pregnant women, shortened the labor duration
because of the pressure on the cervix, and positively affected
the
newborns.9,10,22 Newborns in the experimental groups had
higher
first minute, fifth minute, and tenth minute oxygen saturation
levels
than did the control group. Previous studies that examined the
effects

on newborns of non-pharmacological methods used in the
manage-
ment of labor pain have evaluated their mean Apgar scores and
sta-
tuses regarding hospitalization in the intensive care unit.9,10,22
The
first and fifth minute oxygen saturation levels in this study
agree
with those of previous studies. Not only did the labor dance
have a
positive effect on newborns’ fifth and tenth minute oxygen
saturation
levels, but it also ensured a greater effect when the practice was
per-
formed with a spouse.
Findings obtained in this study also reveal that labor dance ren-
ders positive effects not only on newborn babies but also on
women
giving birth (Table 6). One of the most crucial components of
labor
dance is the physical and emotional support offered during
labor.
Previous studies that have examined support during pregnancy,
labor, or the postpartum period state that pregnant women or
women who recently gave birth always need social support, yet
the
support of the spouse or partner is particularly significant.
Another
study stated that back massage applied to pregnant women
during
labor increased mothers’ birth satisfaction.30 Abdolahian et al.
(2014) found the birth satisfaction of pregnant women who
danced
with their spouses to be significantly higher than those who did
not

dance.25 These study results are compatible with the literature.
Labor dances performed with spouses helped women to be
satisfied
with the labor experience. Ferrer (2016) compared the effects of
humanistic and medical care models on women’s birth
satisfaction
during the intrapartum period. In a humanistic care model,
women
are allowed to be overseen by their partners and/or another
person
in the phases of labor, birth, and after birth. At the same time, it
is
recommended to avoid redundant interventions (constant
monito-
rization, intravenous infusion, amniotomy, etc.). The study
found
that women who were attended to under the humanistic care
model
had significantly higher levels of satisfaction with their health
professionals, their babies, and their spouses than those who
were
attended to under the biomedical care model.31 The humanistic
care
model displays similarities to mother-friendly hospital
practices. All
pregnant women were provided care using mother-friendly
hospi-
tal practices. Satisfaction subscales, except for satisfaction with
the
physician and the total scale score of the experimental groups,
were
higher than those of the control group. Mother-friendly hospital
practices have positive effects on mothers’ satisfaction; further -
more, labor dance enhances this positive effect. Similarly,
another
study stated that pregnant women who underwent the labor pro-

cess with the support of health professionals or relatives in a
spe-
cially prepared room were more satisfied than were pregnant
women who had routine care.32 Smith stated that aromatherapy,
music, and massage did not affect women’s birth satisfaction;
how-
ever, hypnosis positively affected their satisfaction.10 Sandall
et al.
(2016) examined 15 studies of 17,674 pregnant women,
comparing
their care with other care models under the leadership of
midwives.
Services such as evaluating low-risk pregnant women’s needs
during
the antepartum, intrapartum, and postpartum periods; care
planning;
and referring patients to relevant specialists were provided
under the
leadership of midwives. This kind of care was provided by
health pro-
fessionals such as obstetricians, family physicians, and
obstetrician
nurses in other care models. The satisfaction status of women
who
received care under the leadership of midwives was found to be
high
compared to the women in other groups.33 The concerns of the
preg-
nant women and their partners and spouses increased when the
mid-
wives left them alone during the labor process. The midwives
constantly provided personal care, which pleased the pregnant
women. This satisfaction helped them to perceive the clinical
environ-
ment and all employees positively and to enhance psychological
and

physiological healing.34 It is highlighted that pregnant women
in the
experimental groups were never left on their own during the
labor
process in this research, and the non-presence of constant
monitoring
by the spouse or midwife affected women’s birth satisfaction in
a posi-
tive way.
Labor dance is a novel method that helps pregnant women,
fami-
lies, and midwives cooperate during labor and contributes to
preg-
nant women’s spouses/partners being able to manage pain
experiences during the first phase of labor. Since labor dance is
prac-
ticed with one’s spouse/partner and midwives, this study was
con-
ducted in a mother-friendly hospital that allows spouses to be in
the
delivery room. In order to popularize labor dance and help
pregnant
women’s families contribute to intrapartum care, it is suggested
to
conduct dance practices in a wider sampling with other
attendants a
pregnant women would ask for (mother, sister, or friend) and in
insti-
tutions that are not mother-friendly.
5. Conclusion

The results of this study demonstrated that labor dance
positively
affected labor pain, birth satisfaction, and neonatal results. The
labor
dance was important; however, whether dancing occurred with a
spouse/partner or midwife did not affect the study results. The
preg-
nant women wanted their midwives’ company as much as they
needed their families’ presence during labor, which is one of the
most special moments of their lives. This study supports the
“Mid-
wives, Mothers, and Families: Partners for Life” theme of the
2017
International Confederation of Midwives (ICM).
Author Contributions
B. A. and B. K. S. designed the study, analyzed the data, and
drafted
the manuscript; B. A. conducted the data collection and drafted
the
manuscript, as well as conducted the study and data collection.
All
the authors read and approved the final manuscript.
Ethical Approval
All participants gave written consent to participate. Ethical
approval was obtained from the Ege University Research Ethics
Com-
mittee reference (24.03.17/ 17-3/8). All participants gave
written
consent to anonymised quotes being used in publications.
Funding Sources: There is no funding in the study
Clinical Trial Registry and Registration number: NCT04196660

Declaration of Competing Interest
The authors declare that there is no conflict of interest.
Acknowledgement
This article was derived from a doctoral thesis. This paper was
presented as an oral presentation at the 47th Global Nursing and
Healthcare Conference in London between 1 and 3 March 2018.
Supplementary materials
Supplementary material associated with this article can be
found
in the online version at doi:10.1016/j.explore.2020.05.017.
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/ Exp
Bihter Ak{n She worked as a midwife for about 15 years.
She is currently working as a faculty member in midwifery
department. There are published many articles and book
chapters on birth, birth pain, prenatal education.
B. Akin and B.K. Saydam
Birsen Karaca Saydam Assoc. Prof Birsen karaca Saydam,
who was borned in Karşıyaka, _Izmir. Her professions are
reproductive health, infertility, obstetrics and gynecologic
nursing, gynecological oncology nursing, gender equality in
society and health education. Currently she has been con-
ducting the Assos. Prof. Position in Ege University Faculty of
lore 16 (2020) 310�317 317
Health Science Midwifery Department.
The effect of labor dance on perceived labor pain, birth
satisfaction, and neonatal outcomes1. Introduction2. Materials
and Methods2.1. Design2.2. Participants2.3. Data collection
tools2.4. Data collection procedures and labor dance2.5.
Analysis2.6. Ethical considerations3. Results4. Discussion5.
ConclusionAuthor ContributionsEthical ApprovalDeclaration of
Competing InterestAcknowledgementSupplementary
materialsReferences

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