sara esmaelzadeh-saeieh

Studies have indicated contradictory results concerning the impact of protein-based diets on very low birth weight neonates. Hence, this study explored the impacts of various calorie and protein diets on the growth of very low birth weight neonate during 15 days.
This study was carried out on 44 neonates with very low birth weight, selected regarding the inclusion criteria. They were assigned into two clusters based on their birth weight. Each cluster included a control group receiving the standard diet formula, and an experimental group with neonates weighing 1000-1500gr who followed a high-energy diet with 4gr protein and those weighing less than 1000gr who received a high-energy diet with 4.2gr protein. Finally, the neonates' weight, height, and head circumference were measured every 3 days for 15 days.
According to the findings, the mean weight of  the neonates who weighed between 1000 and 1500gr was higher in the intervention group from the third day after initiating the diet, though no significant difference was observed. Similarly, the mean weight of intervention group in the second cluster was higher than the neonates in the control group from the third day with a statistically significant difference on the 15th day. Moreover, no significant difference was found in other measurements between groups.
The results demonstrated the effect of a higher weight of protein intake group on the 15th day. Hence, it recommends providing higher protein intake formula to lower infant birth weight for better growth.

The prevalence of COVID-19 in the world and the long closure of universities necessitate attention to virtual education, e-learning readiness, and student satisfaction.

The present study is a descriptive-analytical study of structural equations that was performed on 216 students studying at Alborz University of Medical Sciences during the COVID-19 pandemic. The multi-stage sampling method was determined in the first stage of the schools and the second stage sampling was done randomly. Data were collected by electronic questionnaires of fear of COVID-19, e-learning readiness, motivational belief, and student satisfaction. Data were analyzed by using SPSS and LISREL 8.8 software. Statistical significance was (P-value< 0.05).

The results of study showed fear of COVID-19 had a significant and positive effect on student satisfaction (β = 0.22, P=0.001). Motivational belief also had a significant and positive effect on e-learning readiness (β = 0.76, P=0.001) and also, e-learning readiness had a significant and positive effect on student satisfaction (β = 0.51, P=0.001).

Despite the student’s dissatisfaction with the virtual education system, the fear of COVID-19 increases their satisfaction with virtual education, so providing the necessary protocol for virtual education in times of crisis and natural disasters increases students' satisfaction with virtual education.

The measurement of total serum bilirubin is a stressful diagnostic method; therefore, it is necessary to measure bilirubin levels using non-invasive ways. The present study aimed to assess the relationship between bilirubin levels measured using three methods of transcutaneous, serum, and Kramer’s scale in term neonates with jaundice.
This descriptive-analytical study was conducted on 180 full-term neonates admitted to Imam Ali Hospital in Alborz province, Iran. Bilirubin level was measured by three methods of serum, transcutaneous (using MBJ20, B&M Technology Co., China), and Kramer’s scale (based on the appearance) before phototherapy. Thereafter, the relationship between serum bilirubin levels using transcutaneous and Kramer’s scale was determined by the Pearson and Spearman correlation coefficients.
The correlation coefficient between serum bilirubin and transcutaneous bilirubin (TCB) was obtained at 0.915 before phototherapy. Furthermore, the correlation coefficients between serum bilirubin and TCB were calculated at 0.881 and 0.77 in the covered and uncovered areas after phototherapy, respectively. The correlation coefficient between TCB in the covered and uncovered areas was 0.81. The mean difference between serum bilirubin and TCB was 0.42±1.25 before phototherapy. Moreover, the mean difference values between serum bilirubin and TCB were reported as 1.36±1.37 and 83.1±63.4 in the covered and uncovered areas after phototherapy, respectively.
As evidenced by the obtained results, there was a significant correlation between TCB and serum bilirubin before the initiation of phototherapy. Therefore, it is recommended to use TCB instead of repeated blood sampling to follow and monitor neonates.

The birth of a premature neonate causes increasing possibility of postpartum depression in mothers. The most important parental needs of infant admitted to the neonatal intensive care unit are communicational and informational needs, the present study aimed to investigate the effect of Interpersonal psychotherapy on postpartum depression  in mothers of infants admitted to neonatal intensive care unit.

This randomized interventional study investigated 92 primiparous women with a newborn admitted to neonatal intensive care unit. of Kamali Hospital. Sampling method was available and samples were randomly assigned into 2 groups of control and intervention by four blocks randomization method. In addition to routine care, the intervention group received 3 IPT counseling sessions. The data collection tool in this study was Edinburg Questionnaire.

There was no statistically significant difference in demographic characteristics between the control and intervention groups. The results of repeated measure test indicated that the postpartum depression  had a significant change over time (p = 0.000) with significant differences between the two groups (p = 0.000).

Considering the impact of IPT on postpartum depression, as well as the limited duration and cost of this program and the possibility of training it by midwives and medical staff, it is suggested to include this training program in the routine interventions for mothers with a newborn hospitalized in neonatal intensive care unit.

Unwanted pregnancy affects the physical and mental health of the mother and her child. Unwanted pregnancy may lead to an increase in gestational hypertension, diabetes, preterm delivery, low birth weight, and postpartum depression. The aim of this study was to investigate the relationship between the incidence of pregnancy and pregnancy complications,  and postpartum depression in women referred to selected health care centers in Robat Karim in 2018-19.

This cohort study was carried out with the participation of mothers referring to health care centers of Robat Karim in 2018. A total of 240 pregnant women entered the study after the completion of the London questionnaire in the 26th week of the week, of which 120 were unwanted pregnant and 120 were asked in the pregnancy group. Data were collected using demographic questionnaire, Edinburgh postpartum depression and a checklist for collecting complications and pregnancy outcomes. Data were analyzed using SPSS-21 software, Chi-square and Chi-square tests.

The mean (SD) of mothers' age in the wanted pregnancy group was 30.1 (7.1) and 29.9 (7.2) in the unwanted group. The mean ± SD of depression scores 10 days after delivery in wanted group was less than unwanted group (10.1 ± 0.3 vs.13.1 ± 2.5, P <0.001) and, 30 days after delivery in the wanted group was less than unwanted pregnancy group (9.4 ± 3.2 vs.13.4 ± 2.5, P <0.001). Breast feeding in unwanted pregnancy was significantly less than wanted group (24.3% vs. 71.7%). The mean(SD) of newborn weight in wanted group was more than unwanted group (3135.3(220) vs. 3001(209.7), P<0.001). Hypertetion, diabetes, postpartum hemorrhage, NICU hospitalization and maternal hospitalization in ICU were not different in both groups but pre-eclampsia (7.5% vs. 1.7%, P=0.03) and preterm labor (17.5% vs. 5%, P=0.002) in unwanted group was more than wanted group.

The study showed that preterm delivery, lack of breastfeeding, preeclampsia, and postpartum depression were more in unwanted. Therefore, it can be concluded that wanted pregnancy is related to pregnancy complications, childbirth consequences and postpartum depression.

The infertility experience and its treatment are accompanied by the symptoms of posttraumatic stress disorder (PTSD). The aim of this study was determining the relationship between posttraumatic stress disorder and quality of life and the infertile women’s stress.

In this descriptive-analytic study, 172 infertile women were divided in four groups. Convenience sampling was done and eligible infertile women referred to Qafqaz Infertility Center in Iran were included in the study. The data was collected between January and March 2019 through posttraumatic stress disorder checklist, The Fertility Quality of Life (FertiQoL) questionnaire, and Newton's infertility stress questionnaire. Pearson correlation, linear regression analysis, and two-way analysis of variance (ANOVA) were applied for data analysis with a significance level of 0.05.

The results of two-way analysis of variance (ANOVA) revealed that there was no significant relationship between the type of treatment (p=0.548) and the reception of psychological intervention (p=0.450). In addition, the results of Pearson correlation showed that there was an inverse significant relationship between the total score of posttraumatic stress disorder and quality of life (r=-0.91, p<0.001) and a direct relationship between the total score of posttraumatic stress disorder and level of stress (r=0.56, p<0.001).

The results of this study showed that 41.3% of the infertile women had the symptoms of posttraumatic stress disorder. Due to the relationships of posttraumatic stress disorder with the quality of life and infertility stress, providing regular designed psychological interventions is recommended for infertile individuals.

Women with high-risk pregnancy are at increased risk of depression and anxiety during pregnancy, as well as a less favorable parent-infant interaction. This study aimed to investigate the effect of midwife-led psycho-education intervention on parental stress, competency, and postpartum depression in nulliparous women hospitalized with high-risk pregnancy.

This randomized controlled trial was carried out on 66 nulliparous women admitted to the high-risk pregnancy ward of Kamali Hospital, Karaj, Iran. Using convenient sampling method, the mothers were randomly assigned to control and intervention groups. In addition to routine care, the intervention group received four sessions of midwife-led psycho-education intervention in two group sessions in pregnancy and two individual sessions immediately after delivery. The parental stress, parental competency, and postpartum depression questionnaires were used for data collection before, after, and one month after the intervention. Data were analyzed using SPSS software ver. 13.0. Repeated-measures ANOVA test was used for comparing the mean scores of parenting stress, parental competency, and depression between and within both study groups before, after, and one month after delivery.

While postpartum depression and parental stress decreased in intervention group, parental competency increased.

Our findings indicated that midwife-led psycho-education was effective on parental stress, competency, and postpartum depression in high-risk pregnancy mothers. Accordingly, prenatal distress in high-risk pregnancies should be assessed routinely.

Multiple sclerosis (MS) is the most prevalent progressive sensory/neurological disability in young adults, with important psychological consequences. The present study was designed to assess the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction in women with MS. In this clinical trial, conducted from January 2018 to May 2019, in the MS Referral Center of Tehran (Iran), 72 eligible participants were assigned to intervention and control groups (36 in each group) via simple randomization. The intervention group received group counseling based on the client-centered approach, while the control group received routine counseling. Data were collected using the Larson Sexual Satisfaction Questionnaire (LSSQ) at three different time points: before the intervention, after the final session, and one month after the intervention. The collected data were analyzed in SPSS software (version 19). In order to analyze the obtained data, independent t test, Mann–Whitney U test, paired t test, Wilcoxon test, Chi-square test, Fisher exact test, and Friedman test were used. The mean score of sexual satisfaction before the intervention showed no statistically significant difference between the two groups. Based on the Friedman test in the intervention group, the trend of changes in the mean score of sexual satisfaction had a significant difference before the intervention, after the final session, and one month after the intervention (P=0.001); however, no significant difference was observed in the control group. Our results showed the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction and intimacy among women with MS. Trial Registration Number: IRCT20180110038302N3.

Breast cancer has a high prevalence, constituting a major cause of mortality in women around the world. Health literacy has a vital role in the self-care of chronic diseases such as cancer and is an essential element in the ability of each person to engage with health promotion. The aim of this study was to determine effect of health literacy counselling on selfcare in women after mastectomy.

This study is a randomized, controlled, clinical trial carried out on 72 women with breast cancer after mastectomy in Fars province. The eligible women entered the study using convenience sampling and were then divided into an intervention and a control group through randomized blocks of four. Health literacy questionnaire and self-care questionnaire were distributed among the participants before, immediately after and three weeks following the intervention. Data analysis was performed in SPSS ver.13.

The results showed no significant differences between the two groups in terms of their health literacy and self-care scores before the intervention (P=0.299 and 0.059). A comparison of the mean values showed a greater increase in the mean score of health literacy and score of selfcare immediately and three weeks after the intervention in the intervention group compared to the control group. Also, the mean score of the dimensions of self-care in chemotherapy increased over time in the intervention group.

The findings of this study confirm the higher effectiveness of counseling with a health literacy approach on overall self-care in chemotherapy and all its dimensions.

Maternal nutritional behavior before and during pregnancy contributes significantly to improving the outcomes of pregnancy and the health of the newborns after birth. In addition, the theory of planned behavior (TPB) is a proper model for use during pre-pregnancy and pregnancy. Therefore, the present study evaluated the effect of TPB education on nutritional behaviors of overweight and obese women before pregnancy.

This randomized controlled trial was conducted on 100 overweight and obese women who attended a nutrition unit in Khansar during April-August 2017. A convenient sampling method was used and the samples were randomly divided into intervention and control groups. The intervention group participated in five nutritional training sessions based on the TPB in addition to routine care. Data were collected with TPB and nutritional behaviors questionnaires before, after, and 2 months after education. Finally, the Student’s t test, Fisher exact test, as well as Mann-Whitney U test, chi-square and repeated-measure tests were utilized for data analysis.

Based on the result of the repeated measure test, the overall score of the TPB changed (P=0.002) over time and a significant difference was observed between the 2 groups (P=0.002). In addition, the result of the repeated measure test indicated that the length of time affects the nutritional behavior score (P=0.000) and there was a significant difference between the 2 groups in this regard (P=0.000).

Considering the effect of training, based on the TPB, on nutritional behavior, the content of this training is suggested to be included in the pre-pregnancy program.

Infertility stress can have a devastating impact on the lives of couples and influence their physical and psychological health. The purpose of this study was to investigate the effects of group counseling on female stress and gender-role attitudes in infertile women. The present study is a randomized clinical trial conducted on 90 infertile women referred to Rooyesh Infertility Treatment Center in the city of Karaj, Iran. The convenience sampling method was used. Samples were divided into intervention and control groups through four-block random allocations. Accordingly, the intervention group received five-session group counselling and the control group only received routine care. Newton’s fertility problem inventory (FPI) and gender role questionnaire (GRQ) were used for collecting data before, after, and one month after the intervention. The significance level was set at 0.05. The result showed a significant relationship between gender role attitude and stress in infertile women (p=0.03) and indirect association between of them (r=0.13). And also repeated measures test indicated that length of time had affected the total scores of infertility stress (p<0.001) and gender role attitude scores (p=0.001) and there was a significant difference between the two groups in infertility stress scores (p<0.001) and gender role attitude scores (p=0.001). Group counseling can be used in stress reduction and also improved gender role attitude of infertile women.

Post-spinal puncture headache (PSPH) has constantly been one of the research priorities, especially in women undergoing cesarean section (C-section) and it is related to physical and psychological problems. The present study aimed to evaluate the effect of ginger on preventing PSPH in patients undergoing C-section. This clinical trial was conducted on 160 women undergoing C-section with spinal anesthesia, who were eligible to enter the study in the experimental and control groups. One ginger capsule (250 mg) was prescribed every 8 hours (TDS) to the experimental group 24 hours before the C-section. The prescription of ginger was continued half an hour after transfer to the post-partum ward until the PSPH onset. PSPH intensity was measured by using visual analog scale (VAS) pain scores at 6 time-points (Time 1 = 30, Time 2 = 60, and Time 3 = 90 minutes vs. Time 4 = 3, Time 5 = 6, and Time 6 = 12 hours) after C-section. No interventions were performed in the control group. The data were analyzed using the SPSS software by descriptive statistics and analytical tests were applied to determine the changes in PSPH intensity. The comparison results of the mean score of PSPH intensity in the experimental and control groups indicated significant differences over time (P < 0.05), except for the sixth time point (12 hours after C-section). In addition, the trend of changes at 6 time-points based on the results of the repeated-measures test demonstrated that PSPH intensity significantly differed in the two groups over time (P < 0.001). Based on the result, the oral prescription of ginger to women undergoing C-section under spinal anesthesia led to effective PSPH prevention at 5 time-points (30, 60, and 90 minutes, along with 3 and 6 hours). Further, the trend of the changes represented that the intensity of PSPH decreased in the experimental group over time. Therefore, ginger is suggested as a non-invasive and efficient method used for preventing PSPH.

The present study aimed to examine the effectiveness of group counseling on parents’ self-efficacy, knowledge, attitude, and communication practice in preventing sexual abuse of children aged 2-6 years.
A randomized controlled clinical trial was carried out on 62 parents in Karaj (Iran) during the period of March-November 2016. Three kindergartens were randomly selected using the cluster sampling technique. Block randomization was used to assign the participants into two groups (N=31 in each group), namely the intervention group and the control group. Data collection included demographic characteristics, a “Parental Knowledge, Attitude, and Practice” questionnaire on the prevention of child sexual abuse, and the Farrell and Walsh self-efficacy pretest-posttest. The participants in the intervention group attended a counseling program of a 90-minute session per week, for 3 consecutive weeks. The participants were evaluated before, immediately after, and one month after the intervention. All statistical analyses were performed using the SPSS software (version 19.0). Data were analyzed using the Chi-square, independent t-test, Mann-Whitney, and Friedman tests. P There was no significant difference between the intervention and control groups in terms of the mean knowledge (P=0.50), attitude (P=0.48), practice (P=0.93), and self-efficacy (P=0.43) before the intervention. However, a significant difference was observed between the groups immediately after (P Counseling is an effective tool in increasing the self-efficacy of parents on child sexual abuse. The awareness of child sexual abuse and its prevention should be raised in the society through effective training programs.

Labor pain is a major reason behind preferring cesarean section over normal vaginal delivery. Aromatherapy is among the most common nonpharmacological therapies for pain.
The objective of this study aimed to evaluate the effects of inhalation aromatherapy with Boswellia carterii (BC) essential oil on the intensity of labor pain among nulliparous women.
This randomized controlled trial was carried out on 126 nulliparous women. Women were randomly allocated to an aromatherapy (n = 63) and a placebo (n = 63) group. For each woman in the aromatherapy group, a piece of gauze was soaked with 0.2 ml of 0.2% BC essential oil diluted in 2 ml of normal saline, and then, it was attached to the collar of each woman. The intervention was repeated for each woman every 30 min up to a cervical dilation of 10 cm. The intervention in the placebo group was the same as the aromatherapy group except that the gauze was soaked only with 2 ml of normal saline. A numeric pain rating scale was used to assess the labor pain intensity before the intervention and at cervical dilations of 3–4, 5–7, and 8–10 cm. Statistical analyses were performed using descriptive and inferential statistics such as the Chi-square, the independent sample t- test, and paired t-test.
Between-group comparisons revealed that labor pain intensity in the aromatherapy group was significantly lower than the control group at cervical dilations of 3–4 (4.98 ± 0.93 vs. 6.68 ± 1.28, P 0.05).
Inhalation aromatherapy with BC essential oil has positive effects on labor pain. Therefore, it can be used for relieving labor pain in the first stage of labor.

Developing maternal competence in first time mothers has a significant impact on neonate’s growth psychosocial development and neonates growth and psychological development. Social support can be an important element for becoming a new mother. We aimed to investigate how social support and maternal competence change during pregnancy and 4 months after it and examine the relationships among social support and maternal competence.
This longitudinal study was conducted on 100 first time mothers attending health centers in Alborz city, Alborz Province, between February 2015 and January 2016. Data were collected through perceived social support questionnaire that consisted of 12 questions and Parenting Sense of Competence Scale consisting of 17 items scored based on Likert’s scale. The collected data were analyzed by SPSS software, version 16. Repeated-measure test and Pearson’s correlation coefficient were used. P Maternal competence significantly reduced during the study (P=0.008), while perceived social support did not show any significant reduction (P=0.286). A direct relationship was found between social support and maternal competent six weeks after childbirth (r=0.19, P=0.049), and also social support and maternal competence sixteen weeks after childbirth (r=0.23, P=0.01).
Considering the reduction of maternal competency during the study, social support by healthcare providers may be helpful for the mothers’ transition to motherhood, and midwives must design specific interventions to promote the sense of maternal competence and perceived social support in first time mothers.

Aim: This study aimed to evaluate the impact of self-care consultation on the nutrition and physical activity of women who are planning for pregnancy in Karaj, 2016.
In the present study, 40 women who were planning for pregnancy constituted the research sample who were selected by convenience sampling. Data collection tools included demographic questionnaire and self-care check list based on “CDC preconception health indicators, 2009”. Consultation was done based on 5A (asses, advise, agree, assist and follow-up) model. Self-care score scope was measured before, one month and three months after consulting in the area of nutrition and physical activity (with 19 questions). This study was approved by the Ethics Committee of Alborz University of Medical Sciences. Also a clinical trial registry (IRCT2016042827557N2) was performed. Sampling was performed from April to December 2016. One and three months after counselling sessions, the follow-up was done. SPSS v22 and Friedman and Wilcoxon tests were used to analyze the data at the significance level of 0.05
Findings: The results showed that the self-care level of women planning for pregnancy in the area of nutrition has changed significantly one month (p=0/001) and three months (p=0/0001) after consultation. Also their physical activity increased significantly one month (p=0/001) and three months (p=0/0001) months after consultation.
Counselling based on self-care plays an important role in improving the nutrition and physical activity of women planning for pregnancy. Based on individual capabilities, focusing on self-care can promote their performance in the area of nutrition and physical activity before pregnancy.

Communication has a fundamental role in marital life and lack of effective communication is a common compliant of married couples attending counseling and treatment centers.
This study was conducted to examine the effect of communication skills on marital satisfaction of couples attending premarriage counseling centers.
This parallel interventional study was conducted on 60 couples who attended a premarriage counseling center (Shahid Rast Ravesh) affiliated to Alborz University of Medical Sciences. A simple sampling method was used and samples were allocated into the intervention and control groups using blocks randomization. The intervention group, in addition to the routine trainings, received training on communication skills and sexual relation. The Enrich’s marital satisfaction questionnaire was completed by the participants in both groups before, after and two months after the intervention.
The mean age of the couples was 24.9 ± 4.7 years in the intervention group and 25.8 ± 4.1 in the control group. Twenty participants (66.7%) in the intervention group and 19 participants (63.3%) in the control group had diploma. Also, 13 persons (43.3%) in the intervention group and 12 persons (40%) in the control group were self-employed. There was no statistically significant difference between the two groups in socio-economic traits of the couples. The results of repeated measures showed that marital satisfaction has changed over time (P Considering the effect of communication skills on marital satisfaction of the couples, it would be suggested to include the content of communication skills in the premarriage education class.

Prenatal mortality is important indicator of health and health care services at birth, therefore understanding the major prenatal mortality causes will help the society to plan better prenatal and neonatal care system.
This study aimed to determine the causes of Prenatal Mortality in Medical Centers of Alborz Province
This was a retrospective study conducted on 446 cases of intrauterine and neonatal deaths in 2012 which occurred in Medical Centers of Alborz Province and was recorded by relevant authorities in the application INFO PATH. Data were analyzed using descriptive statistics, chi-square test.
324 cases (72.6%) died in the uterus and 122 cases (27.4%) of neonate died after birth from 44.6 cases intrauterine and neonatal deaths, most time elapse of death was 50 hours after birth. 101 cases (24%) of death at birth was due to congenital abnormality and 62 patients (61.4%) were in the group of intrauterine deaths and 39 cases (38.6%) in the group of death 30 days after delivery. The most common congenital abnormality was neural tube defects (15.2%). 57 (12.8 %) mothers had disease and diabetes was the most prevalent (3.8%). By category (ICD10) in this study, the highest rate of fetal death in 359 cases (805%) were in a group of disorders with unknown origin and 186 cases (40.6%) of this group were in sub group of related disorders of duration of pregnancy and fetal growth and premature delivery was the most complication of pregnancy.
Prenatal mortality rate in this study was 11.5 in 1000 live birth. Result of present study showed that most of intrauterine fetal death causes were preterm delivery and unknown death. Therefore, in addition to health needs, identifying the causes of preterm labor and its related factors are also recommended. In this study, none of the causes of death had been determined by autopsy. Autopsy of death due to unknown causes is also recommended so that better and more proper intervention can be taken to prevent intrauterine deaths

Anxiety is the most common psychological response to labor in women. Aromatherapy is a type of alternative medicine which by using es­sential oils and fragrant, stimulates the olfactory system, induces relaxation and reduces anxiety. This study aims to determine the effect of aromatherapy with Boswellia Carteri in reducing anxiety during the first stage of labor.
This randomized clinical trial was conducted on 126 nulliparous women, referred to Kamali hospital (Karaj, Iran). Samples were divided into two groups of aromatherapy and control. In intervention group, gauzes impregnated with 2 ml normal saline and 0.2 mL Boswellia essence, and in control group only with 2 ml normal saline were attached to the collar of subjects. Gauzes were changed every 30 minutes. Level of anxiety in both groups were measured at baseline and after the intervention at dilations of 3-4 and 6-8 cm. Data was collected using a demographic and obstetric information questionnaire, an observation-examination checklist, and Spielberger state-trait anxiety questionnaire.
Before the intervention; gestational age, Bishop Score, contraction length and level of anxiety was the same in both groups. After the intervention, mean of anxiety in the intervention group at dilations of 3-4 (18.4±5.18) and 6-8 cm (20.3±6) was significantly lower than control group at dilations of 3-4 (22.3±7.98) and 6-8 cm (22.9±5.55), (P=0/014,P=0/002).
The results of this study confirmed aromatherapy with Boswellia Carteri essence as a simple, inexpensive, noninvasive, and effective intervention to reduce anxiety during labor.