Psychosocial Effects of Empathy-Based Midwifery Education on Midwifery Students and Pregnant Women

This two-stage quasi-experimental study will evaluate the effects of empathy-based midwifery education on midwifery students' empathic tendencies and state anxiety, and the effects of care provided by trained students on women's satisfaction with childbirth and perceptions of traumatic birth. The study links a structured educational intervention with its subsequent application in the clinical setting.

In the first stage, third-year midwifery students enrolled in the Normal Birth and Postpartum Period course and participating in delivery room clinical placements will be invited to participate. The minimum required student sample is 82. All 84 students enrolled in the eligible class will be invited, and consenting students will be assigned to intervention and control groups in approximately equal numbers. If all eligible students participate, each group will include 42 students. Both groups will receive the same routine course curriculum and clinical education.

Students in the intervention group will additionally receive a face-to-face, group-based empathy education program delivered over two weeks, with two sessions per week. The program comprises four sessions totaling 390 minutes and will take place outside routine course and clinical placement hours. The first session will address empathy, empathic tendencies, woman-centered midwifery care, and respectful maternity care through theoretical instruction, questions and answers, and group discussion (90 minutes). The second session will focus on empathic communication during labor, including recognition of women's fear, anxiety, pain, uncertainty, and support needs, using case discussions and role-play (90 minutes). The third session will involve a virtual reality delivery room experience and structured scenarios using a simulation mannequin to practice empathic communication, reassurance, information provision, privacy protection, and supportive care (120 minutes). The fourth session will include debriefing, feedback, and group reflection to support preparation for clinical practice (90 minutes). Control group students will continue routine education and clinical placements without receiving the additional structured program during the study period.

Student demographic characteristics and previous educational and clinical experiences will be recorded using a Student Information Form. Empathic tendencies and state anxiety will be assessed before and after the educational intervention using the Empathic Tendency Scale and the State Anxiety Inventory, respectively. Changes within groups and differences between groups will be evaluated.

In the second stage, 140 women admitted to the delivery room during labor will be enrolled in intervention and control groups. Eligible women will be aged 18 years or older, at 37-42 weeks of gestation, have a singleton live pregnancy, plan a vaginal birth, be able to communicate in Turkish, and provide informed consent. Sociodemographic characteristics and obstetric history will be recorded at admission using a Pregnant Woman Information and Obstetric History Form.

Women in the intervention group will receive empathy-based communication and psychosocial support from students who have completed the educational program, under the supervision of a faculty member and/or the responsible midwife. The approach will include active listening, recognition of emotional and individual needs, respectful and nonjudgmental communication, clear explanations, reassurance, protection of privacy, support for coping with labor, and appropriate responses to questions. This support will be provided alongside routine clinical care. Clinical decisions and management will remain the responsibility of the healthcare professionals in the delivery room.

Intervention fidelity will be evaluated using a researcher-developed Empathy-Based Midwifery Approach Implementation Checklist finalized following expert review. A supervising faculty member and/or responsible midwife will complete the checklist during clinical practice. Each behavior will be recorded as performed, not performed, or not required.

Women in the control group will receive routine delivery room care, including admission assessment, maternal and fetal monitoring, monitoring of labor progress, indicated clinical care, and postpartum maternal and newborn observation. They will not receive the additional structured psychosocial support intervention from students trained in the study program.

After birth, once the mother and newborn are clinically stable, maternal satisfaction will be assessed using the Scale for Measuring Maternal Satisfaction in Normal Birth, and perceptions of traumatic birth will be assessed using the Traumatic Birth Perception Scale. Higher maternal satisfaction scores indicate greater satisfaction with care, whereas higher traumatic birth perception scores indicate a more negative perception of the birth experience. Women who develop an indication for emergency cesarean delivery, fetal distress, or serious maternal or neonatal complications, or who cannot complete the postpartum assessments, will be excluded according to the study protocol.

Data will be analyzed using descriptive statistics and appropriate parametric or nonparametric tests. Student outcomes will be compared within groups over time and between intervention and control groups. Maternal outcomes will be compared between groups. Analysis of covariance will be used when appropriate to account for baseline student scores.

Participation will be voluntary, and informed consent will be obtained from students and women before data collection. Students' decisions regarding participation will not affect their grades, course assessments, or academic rights. The study will assess whether structured empathy education improves student outcomes and whether its supervised clinical application improves women's childbirth experiences.