Overview

This study tests whether a nurse-led "4-step narrative nursing" program can reduce anxiety and improve breastfeeding confidence in mothers who are having a planned or non-emergency cesarean section.

What is the problem? About 30-40% of Chinese cesarean mothers feel high anxiety after surgery, and 1 in 5 is at risk for postpartum depression. Low confidence in breastfeeding is also common.

What will we do?

We will randomly assign 160 mothers (1:1) to either:

Usual care - standard education and ward care, or

Usual care plus narrative nursing - four short (10-20 min) conversations with a trained nurse:

Before surgery - help the mother talk about her fears. 24-48 h after surgery - encourage her to "name" pain or worries and separate them from herself.

Before discharge - guide her to find positive moments and build a "strong-mom" story.

Two weeks later by phone - strengthen the new story and review feeding success. What will we measure? Main result: anxiety score at 48 h (STAI scale). Other results: depression risk, breastfeeding confidence, pain, and feeding rates up to 3 months.

Possible benefits:

Lower anxiety, better mood, higher breastfeeding rates. No drugs or extra procedures are involved, only talking.

Risks

Minimal; some mothers may feel emotional during conversations, but nurses can pause or refer to counselling if needed.

Eligibility

Inclusion Criteria:

1. Women aged 18-50 years
2. Scheduled for elective or non-emergency cesarean section at ≥37 weeks
3. Able to communicate in Mandarin and provide written informed consent
4. Expected hospital stay ≥24 h
5. Singleton pregnancy with stable maternal and neonatal condition allowing routine mother-baby contact

Exclusion Criteria:

1. Severe psychiatric disorders (schizophrenia, bipolar disorder, active suicidal ideation)
2. Maternal or neonatal need for ICU/NICU admission
3. Emergency cesarean section preventing baseline assessment
4. Communication or cognitive impairment precluding interview