Digital prenatal group care linked with lower stress and safer childbirth feelings

A four-week digital-integrated group prenatal-care program was associated with lower late-pregnancy stress, more positive childbirth expectations and a stronger sense of safety during vaginal delivery in a quasi-experimental study conducted at a tertiary hospital in Chongqing, China. The study included 100 pregnant women in their third trimester: 52 joined the digital program and 48 received routine prenatal care. All 52 intervention participants completed the four weekly sessions, while the analysis of childbirth experience and labor records was limited to first-time mothers who had vaginal deliveries.

Researchers recruited participants from January 2024 to December 2025 at the maternity center of the Third Affiliated Hospital of Chongqing Medical University. Eligible women were 28–36 weeks pregnant, carrying a singleton fetus in a cephalic position, with no abnormalities detected on ultrasound and no identified mental or intellectual impairment that would prevent independent questionnaire completion. Women with obstetric complications such as threatened preterm birth, premature rupture of membranes, cervical insufficiency, cervical cerclage, preeclampsia, pregnancy-induced hypertension, heart disease or other significant pregnancy complications were excluded. The intervention group self-selected into the program, and controls were matched by gestational week and age.

The intervention adapted the Centering Pregnancy model, which combines clinical assessment, health education and social support for groups of women at similar stages of pregnancy. In the digital version, pregnant women and their spouses were placed in WeChat groups organized by gestational week, with each group containing 8–12 pregnant women. Live 90-minute classes were delivered through Tencent Meeting on Saturday evenings. Across four weekly sessions, participants received six hours of education. Family practice assignments were recorded on video and shared with the group, allowing couples to discuss practical aspects of pregnancy, childbirth and infant care with midwives and other medical personnel.

The program combined self-monitoring, interactive education and continuous group support. Participants monitored their weight and fetal movement at home and entered the information in an online health file that medical staff could review remotely. Each class centered on a maternal and infant health theme, using prerecorded demonstrations or live instruction. Concerns submitted through the WeChat group before a session were incorporated into the class discussion. Outside scheduled sessions, group members could share experiences and questions, encourage one another and receive responses from medical staff. The authors described this combination of synchronous classes and asynchronous group communication as a way to retain professional and peer support while reducing dependence on a fixed physical location.

Pregnancy pressure was assessed with the 30-item Pregnancy Pressure Scale, which covers parental role identity, worry about maternal and child health, body-shape pressure and other factors. Each item is scored from zero for no stress to three for severe stress, with higher totals indicating greater pressure. Childbirth expectations were measured with a 37-item questionnaire covering the medical environment, control and participation, spouse support, medical support and expectations of labor pain. Scores range from one to five, with higher scores representing higher expectations. Within three days after delivery, first-time mothers with vaginal births completed a 19-item Chinese Childbirth Experience Questionnaire measuring professional support, participation, personal capacity and perceived safety; higher ratings there reflected more positive experiences. Hospital records supplied labor-stage durations and other childbirth information.

Both groups reported mild pregnancy pressure at enrollment, with no significant difference in total scores or subscale scores. After one month, the median total pressure score was 0.51 in the intervention group, with an interquartile range of 0.28–0.69, compared with 0.66 in the control group, with an interquartile range of 0.40–1.09. The between-group difference was statistically significant in a Wilcoxon rank-sum test, with z = −2.178 and p = 0.029. Within the intervention group, median pressure declined from 0.56 to 0.51, a significant within-group change at p < 0.001. The control group moved from 0.48 to 0.66, but that change was not statistically significant, with p = 0.195. Post-intervention differences also favored the digital group for worry about maternal and child health, with p = 0.043, and body-shape pressure, with p = 0.040.

Childbirth-expectation results similarly favored the intervention after the program, although the pattern was not uniform across every measure. The intervention group’s median total score was 4.32, with an interquartile range of 4.16–4.45, compared with 4.25 in the control group, with an interquartile range of 3.82–4.40; the between-group difference had p = 0.027. Significant post-intervention differences favored the digital group in the medical environment, with p = 0.022, spouse support, with p = 0.040, and control and participation, with p = 0.035. Within the intervention group, spouse support, control and participation and medical support increased significantly, while labor-pain expectation scores declined. The total expectation score improved in a favorable direction within this group, but its within-group change narrowly missed conventional statistical significance at p = 0.063.

Postpartum experience was assessed among 29 first-time mothers in the intervention group and 22 in the control group who had vaginal deliveries. The two groups did not differ significantly in overall childbirth-experience scores or in professional support, participation or personal capacity. Perceived safety did differ: the intervention group reported a median score of 2.50, with an interquartile range of 2.00–2.87, versus 2.00 in the control group, with an interquartile range of 1.50–2.50. The Wilcoxon rank-sum test yielded z = −2.549 and p = 0.011. The result therefore supports a specific association with feelings of safety, rather than a conclusion that every dimension of childbirth experience improved among all participants.

Obstetric records from the same 51 first-time mothers with vaginal deliveries showed shorter labor in the intervention group. Median total labor duration was 350 minutes in the intervention arm, with an interquartile range of 272.50–615.75 minutes, compared with 542.50 minutes in the control arm, with an interquartile range of 336.25–726.25 minutes; the difference had p = 0.043. The first stage of labor had medians of 300 minutes in the intervention group and 450 minutes in the control group, with p = 0.024. No significant between-group differences were detected for the second or third stages, length of hospital stay, analgesia, perineal condition or postpartum hemorrhage. These observations do not demonstrate that the program prevented adverse clinical outcomes.

The researchers interpreted the findings through the Health Belief Model and House’s Social Support Theory. The first framework was used to explain how structured education, peer examples and professional reinforcement might strengthen self-efficacy and perceived benefits of health-promoting behavior. The second accounted for informational, instrumental, emotional and appraisal support delivered through live instruction and ongoing group communication. Explicit partner participation offered a possible route to the higher spouse-support and control-and-participation ratings. These were proposed mechanisms rather than directly tested components: the study did not isolate the effects of education, peer interaction, spouse involvement or professional support from one another.

Several limitations restrict the conclusions and their generalizability. The non-randomized design allowed volunteers to select the intervention, creating potential selection bias related to motivation, health awareness, engagement or digital literacy. Matching on age and gestational week, along with similar measured baseline characteristics, could not exclude unmeasured confounding. Psychological outcomes depended on self-report and were vulnerable to recall and social-desirability biases. Analysis of covariance, ordinarily preferred for non-randomized pre-post comparisons, was not used because most outcome data were not normally distributed. The study took place at one urban tertiary hospital, so the results may not apply to rural areas, different health systems or women with limited internet access or digital skills. The delivery analyses also involved only 51 of the 100 enrolled women, restricting their scope to first-time mothers with vaginal delivery. Within these limits, the study provides evidence of feasibility and association, not proof that digital group prenatal care is universally superior to conventional services or guarantees safer clinical outcomes.

Subject of Research: Effects of digitally integrated group prenatal care on pregnancy stress, childbirth expectations and delivery experience

Article Title: Empowering expectant mothers: the role of digital-integrated GPNC in enhancing childbirth safety and experience

Article References: Xiang, M., Hu, Y., Chen, H., & Zhou, M. (2026). Empowering expectant mothers: the role of digital-integrated GPNC in enhancing childbirth safety and experience. Frontiers in Public Health, 14, Article 1865625. https://doi.org/10.3389/fpubh.2026.1865625

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1865625

Keywords: digital prenatal care, group prenatal care, pregnancy stress, childbirth expectations, perceived safety, labor duration, maternal health, online education, social support, WeChat, Empowering, expectant