Effects of Sleep Quality, Anxiety, and Digital Behavior on Labor Progression in Term Primiparous Women: A Prospective Observational Study

This prospective observational study evaluates whether maternal sleep quality, anxiety levels, and nighttime digital behavior are associated with labor progression among term primiparous women. Sleep quality and anxiety are assessed before the onset of labor during routine antenatal visits using validated instruments, including the Pittsburgh Sleep Quality Index (PSQI) and the Beck Anxiety Inventory (BAI). Nighttime digital behavior characteristics, such as screen exposure and smartphone use prior to sleep, are recorded through standardized antenatal interviews. Labor outcomes, including the duration of the latent, active, and second stages of labor, requirement for oxytocin augmentation, use of analgesia, and mode of delivery, are prospectively documented from hospital admission until birth. By examining behavioral and psychological factors prior to labor onset, the study aims to determine whether poor sleep quality, increased anxiety, or irregular nighttime digital activity are associated with prolonged labor phases or greater need for obstetric interventions.

Inclusion Criteria: * Pregnant women at ≥ 37 weeks of gestation * Completion of PSQI (sleep quality) and BAI (anxiety) assessments during antenatal clinic visit * Singleton pregnancy * Cephalic presentation * Age 18 to 50 years * Planning to deliver at the study hospital * Able to provide informed consent Exclusion Criteria: * Multiple pregnancy * Non-cephalic presentation * Delivery occurring at another hospital or birth center * Elective planned cesarean delivery * Major fetal anomaly * Placenta previa or placenta accreta spectrum * Preeclampsia, eclampsia, HELLP syndrome * Gestational diabetes requiring insulin * Chronic medical disorders affecting labor physiology * Use of sedative, hypnotic, or psychotropic medications * Inability to complete questionnaires