From antenatal preparedness to enacted agency during labor: Integrated findings from a woman-centered intervention on mobility.

INTRODUCTION: Freedom of movement and upright positions during labor are recommended in maternity care, yet organizational routines may constrain women's mobility, autonomy, and shared decision-making. This study examined how a woman-centered antenatal intervention on mobility during labor operated and under which conditions its effects were enabled or constrained. METHODS: A convergent mixed-methods study was conducted in community-based childbirth preparation programs in Portugal. Quantitative data were collected from low-risk nulliparous women at baseline (n=56), post-intervention (n=38), and postpartum (n=30), assessing emancipated decision-making, decision satisfaction, childbirth self-efficacy, birth beliefs, and childbirth experience. Semi-structured interviews were conducted with eight women and four nurse-midwives. Data were analyzed separately and integrated through joint display analysis and meta-inferences. RESULTS: Satisfaction with decision-making improved significantly (3.66 vs 3.70, p<0.001), natural birth beliefs increased (4.14 vs 4.41, p<0.001), and medical birth beliefs decreased (3.74 vs 3.51, p=0.032). No significant antenatal changes were found in emancipated decision-making or childbirth self-efficacy. Women who remained mobile during labor reported higher overall childbirth experience (p=0.005), participation (p=0.011), own performance (p=0.011), and professional support (p=0.015). Qualitative findings showed acceptability and feasibility, highlighting experiential learning, bodily awareness, reflective preparation, and nurse-midwife facilitation as key mechanisms. Integrated findings suggested that antenatal measures primarily captured preparedness for action, whereas agency became more visible when women enacted mobility during labor. CONCLUSIONS: The intervention may strengthen women's preparedness to act regarding mobility during labor, but enacted agency appears to depend on intrapartum relational and organizational conditions.