Design, Implementation, and Evaluation of the Impact of a Second-Stage Labor Management Program on Pelvic Floor Muscle Health: A Mixed-Methods Evaluation Design

To determine the effect of a structured Second Stage of Labor Management Program on pelvic floor muscle health and related postpartum outcomes.

A two-arm randomized controlled clinical trial. Eligible pregnant women will be consecutively recruited and assigned to the intervention or control group according to the group allocation of their attending midwife. Outcomes will be assessed at 8–12 weeks postpartum by trained assessors.

This study will be conducted at Mother Government Hospital in Ramhormoz, Khuzestan Province, Iran. Midwives allocated to the intervention group will implement the Second Stage of Labor Management Program, while those in the control group will provide routine intrapartum care. Outcome assessments will be performed at 8–12 weeks postpartum.

Inclusion criteria included Willingness to participate in the study, Maternal age between 18 and 45 years, Singleton live fetus , Cephalic fetal presentation Low-risk pregnancy, Gestational age between 37 and 41 weeks of pregnancy. Exclusion criteria included Attendance at more than four childbirth preparation classes, Performing perineal massage during pregnancy, Presence of a birth companion (professional labor support midwife/doula or a family member), high-risk pregnancy, contraindications to vaginal birth , maternal medical conditions documented in the medical record .

Participants in the intervention group will receive a structured Second Stage of Labor Management Program aimed at preserving pelvic floor muscle health. Participants in the control group will receive routine intrapartum care.

The primary outcome is pelvic floor muscle strength at 8–12 weeks postpartum. Secondary outcomes include urinary incontinence, bowel dysfunction, pelvic organ prolapse symptoms and sexual dysfunction.

Midwives are divided into two intervention and control groups with a 1:1 allocation ratio using stratified randomization based on the variable of work experience (less than 5 years and 5 years or more). The randomization sequence is generated by an independent person from the research team using a random number table. The final allocation is kept in opaque, sealed, and numbered envelopes and is known only to the independent person until the results are announced.

The documentation will be published as articles on scientific websites.

Access period begins 6 months after the publication of results.

Researchers at academic and scientific institutions, students, and midwives working in public and private centers.

For the purpose of conducting further research or applying the results in clinical settings or scientific documentation.

Articles published on domestic and international scientific and research websites will be accessible.

Scientific articles based on research findings are eligible for publication in journals following rigorous peer review.