Effects of free-position delivery combined with perineal massage on reducing sensitive indicators of care quality in high-risk pregnant women.

Aims: The aim of this study was to evaluate the impact of free-position delivery combined with perineal massage on nursing-sensitive quality indicators and clinical outcomes in high-risk pregnant women. Methods: This retrospective cohort study analyzed clinical data from 223 high-risk pregnant women who underwent vaginal delivery between January 2023 and December 2024. Participants were allocated to either the Traditional Supine Delivery group (TSD, n = 117) or the Free-Position and Perineal Massage group (FPPM, n = 106) based on delivery mode. Baseline characteristics, durations of labor, perineal injuries, postpartum hemorrhage, anesthesia requirements, postpartum complications, neonatal conditions, psychological status, and maternal satisfaction were compared. Results: Compared with TSD, the FPPM group had shorter active first stage and second stage of labor (5.98 ± 1.25 vs. 6.33 ± 1.21 h; 82.01 ± 8.14 vs. 85.48 ± 7.85 min; both p < 0.05), and a lower rate of perineal lacerations (59.43% vs. 76.07%; p = 0.008), episiotomy (16.04% vs. 27.35%; p = 0.042), and postpartum hemorrhage ≥500 mL (5.66% vs. 13.68%; p = 0.045). FPPM also reduced intrapartum anesthesia requirements and postpartum complications while improved 5-min Apgar scores (9.80 ± 0.35 vs. 9.69 ± 0.42; p = 0.036), maternal satisfaction (69.81% vs. 52.14% very satisfied; p = 0.026), and PTSD symptoms (28.44 ± 2.31 vs. 29.52 ± 2.86; p = 0.002). Conclusion: Free-position delivery combined with perineal massage in high-risk pregnant women is associated with better nursing-sensitive quality indicators, lower rates of perineal trauma and postpartum complications, improved neonatal outcomes, and higher maternal satisfaction compared with traditional supine delivery.