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The Presbyterian-Synodal system of church government is based on the ideal theological foundation of Christocracy, the confession that Christ is the sole Head of the Church who rules directly through His Word and Spirit. Theoretically, this model rejects hierarchy, affirms the parity of all ecclesiastical officers (ministers, elders, deacons) as servants, and views the local church council as a complete church (ecclesia completa). However, in historical and contemporary practice, a fundamental tension exists whereby this system consistently deviates into hierarchical and clerical practices. This deviation manifests as a hierarchy of office (clericalism) and a hierarchy of assemblies (Synod-centrism), where authority shifts from Christ to official figures and Synodal structures that are viewed as the "highest court." This article aims to analyze the fundamental causes of this authority shift. Using a qualitative library research method, the author conducts a systematic-theological, historical-critical, and comparative analysis of the works of Reformers (especially Calvin), historical church order documents, and contemporary case studies (such as in Malawi and GMIM). This study concludes that this authority shift stems from two primary factors: First, a "theological deficiency" in many church order documents, which fail to affirm Christ's rule "through His Word and Spirit," stating instead only His rule "through the ministry of officials," thus effectively equating official authority with Christ's authority. Second, the historical legacy of Scottish "national covenant" ecclesiology, which was historically intentionally designed with a centralized authority structure for "godly officials" to "rule over" a mixed populace. The author recommends that churches in this tradition revise their church orders to explicitly re-assert the supremacy of Christ's rule through His Word and Spirit over any human official or synodical authority.

Low back pain is a common complaint among pregnant women in the second and third trimesters due to biomechanical and hormonal changes. Non-pharmacological interventions like prenatal exercise are believed to be effective, though evidence from controlled trials is limited. This study aimed to evaluate the effectiveness of prenatal exercise in reducing low back pain intensity. A quasi-experimental pretest–posttest control group design was used with 30 pregnant women (15 in the intervention group, 15 in the control group), selected by purposive sampling. The inclusion criteria were gestational age of 20–36 weeks, no medical contraindications, and willingness to participate. The intervention group performed prenatal exercises twice a week for 8 weeks (45 minutes per session), while the control group received health education without physical exercise. Pain intensity was measured using the Visual Analogue Scale (VAS). Data analysis was conducted using paired t-test, independent t-test/Mann–Whitney, and ANCOVA to control for age, parity, and BMI. Both groups had homogeneous baseline characteristics (p > 0.05). The intervention group’s pain score decreased from 6.9 ± 1.1 to 3.6 ± 1.0 (Δ = -3.3; p < 0.001), while the control group’s pain score decreased from 6.8 ± 1.2 to 6.3 ± 1.1 (Δ = -0.5; p = 0.09). The difference in pain reduction between groups was significant (p < 0.001). ANCOVA confirmed that prenatal exercise was significantly effective after adjusting for confounders (β = -2.8; p < 0.001). Prenatal exercise is an effective, safe, and affordable intervention for reducing low back pain in pregnant women.

Preeclampsia is a pregnancy complication that contributes significantly to maternal and perinatal morbidity and mortality, especially in developing countries. Despite various preventive measures, preeclampsia is still frequently found at the primary health care level. This study aims to analyze the factors influencing the incidence of preeclampsia in pregnant women at the Tiley Care Community Health Center. This study used an observational analytical design with a cross-sectional approach. The study population was all pregnant women who visited antenatal care at the Tiley Care Community Health Center, with a sample of 60 respondents selected using a total sampling technique. Data were collected through a review of medical records and KIA books, then analyzed univariately and bivariately using the Chi-Square test with a significance level of α = 0.05. The results showed that maternal age, history of hypertension, nutritional status based on body mass index, and adherence to antenatal care visits had a statistically significant relationship with the incidence of preeclampsia. Meanwhile, parity did not show a significant relationship with the incidence of preeclampsia. This study concluded that the incidence of preeclampsia is influenced by various maternal factors and maternal health behaviors during pregnancy. These findings underscore the importance of implementing risk-based antenatal care through early screening, ongoing monitoring, and increased adherence to antenatal care visits as a preventative measure for preeclampsia at the primary healthcare level.

Maternal knowledge of newborn care plays an important role in maintaining neonatal health and preventing early complications. Parity is considered one of the factors that affect the mother's level of knowledge, as previous childbirth experiences can improve the understanding and skills of caring for the baby. However, primipara mothers often face challenges due to limited experience. This study aims to analyze the relationship between parity and newborn care knowledge in primipara mothers at the Tumpunglaung Health Center. The research method uses an analytical quantitative design with a cross-cutting approach. The study population was mothers who had just given birth at the Tumpunglaung Health Center, with a sample of 30 primipara mothers selected through purposive sampling. Data were collected using a structured questionnaire that included maternal characteristics and newborn care knowledge, including breastfeeding, hygiene, thermoregulation, and red flags. Data analysis was carried out by Chi-square test using SPSS at a significance level of p < 0.05. The results showed that most primitive mothers had moderate to low levels of knowledge, with a significant relationship between parity and newborn care knowledge. The conclusion of the study confirms the importance of strengthening education and counseling for primitive mothers to improve infant care practices and support neonatal health.

Preterm birth is a serious threat and a leading cause of neonatal morbidity and mortality in Indonesia. Preterm birth is caused by various factors induding hypertension, paristy, occupation, poor nutritional status, and maternal age during pregnancy. The purpose of this study was to determine the relationship between these faktors and preterm birth at the Pacitan community health Center. Method : The study population was all 420 mothers giving birth in 2023-2024 at the Puskesmas Pacitan, and the sample size was adjusted to the case, resulting in 74 pregnant women with 34 respondens in the case group and 34 in the control group. A retrospective cohorrt study with a case-control approschh was used. Statistical test used chi-square for bivariate test and multivariate tests with logistic regression to analyze categorial data and measure the strength of the relationship. The results of the statistical analysis are as follows: a bivariate test using chi-square analysis of factors affecting the incidence of prematurity revealed maternal age during pregnancy (p-value 0,022), occupation (p-value 0,173), parity (p-value 0,047), nutritional status (p-value 0,047), and hypertension (p-value 0,058). The results of the binary logistic regression test showed that maternal age during pregnancy, parity,and nutriitional status werw all significant (p = 0,000). A nagelkerke  R2 of 1.000 indicated that the model was able to explain 100% of the variation in the incidence of prematurity. Conclusion: there is a relationship between maternal age during pregnancy, parity, maternal nutritional, and hypertension with the incidence of prematurity. There is no relationship between occupation and the incidence of prematurity.

Cervical cancer is a malignant tumor that grows in the cervix caused by infection with the Human Papilloma Virus, acquired through sexual intercourse. Indonesia ranks 8th in the highest incidence of cancer in Southeast Asia, the highest prevalence of cancer is Yogyakarta Province where Sleman Regency ranks the highest IVA positive at 2.5% and Halis IVA at the Pakem Health Center is suspected of cervical cancer reaching 13 out of 22 positive IVA results. This achievement is still very low, because there is still low public awareness to carry out early detection of cervical cancer. To determine the relationship between attitude and behavior for early detection of cervical cancer. Quantitative research with a Case Control approach. A sample of 160 women with a proportional sampling technique. Data collection was in the form of filling out questionnaires online using Google Forms with chi square test data analysis and logistic regression. There was a relationship between positive attitude p-value=0.017 and OR of 3.462, women aged >35 years p- value=0.038, multipara parity p-value=0.007, with early detection behavior of cervical cancer. Parity provided a great chance of 7,038 times that women performed early detection behaviors of cervical cancer (CT 95%= 0.187-264,350). To improve early detection examinations, health workers can design health education and promotion models, increase educational socialization to cadres, the public and the community continuously and sustainably.

In addition to being programmatically successful in lowering TFR and slowing population growth rates, the Long-Term Contraceptive technique (MKJP) is an affordable technique of preventing conception. This study's objective was to examine variables associated with long-term contraceptive (MKJP) selection at the Motoboi Kecil Community Health Center. The study design is cross-sectional and the research methodology is quantitative. The investigation was carried out in the workspace of the Motoboi Kecil Community Health Center. 300 women of reproductive age made up the study's population, and a straightforward random selection procedure was used to choose 45 participants. A questionnaire was used to gather the data, which were then subjected to univariate and bivariate analysis using the Chi-Square statistical test. Age and MKJP choice did not correlate, according to the data (p-value = 0.09 > 0.05). The choice of MKJP was correlated with education (p-value = 0.003 < 0.05). The choice of MKJP was correlated with occupation (p-value = 0.003 < 0.05). The choice of MKJP and the husband's support are related, with a p value of 0.004 < 0.05. Parity and MKJP selection are related, with a p value of 0.003 < 0.05. Knowledge and MKJP selection are related, with a p-value of 0.003 < 0.05.

Human Immunodeficiency Virus (HIV) is the causative agent of Acquired Immunodeficiency Syndrome (AIDS) and can be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. Utilization of Prevention of Mother-to-Child Transmission (PMTCT) services by pregnant women is a crucial strategy to prevent vertical transmission of HIV. This study aimed to analyze factors associated with the utilization of PMTCT services among pregnant women attending antenatal care at Biak Kota Primary Health Center, Biak Numfor Regency. This study employed an observational design with a cross-sectional approach. A total of 80 pregnant women who attended antenatal care at Biak Kota Primary Health Center were selected using purposive sampling. Data were collected using a structured questionnaire. Data analysis included univariate analysis, bivariate analysis using the Chi-square test, and multivariate analysis to identify the most influential factors related to PMTCT service utilization.The results showed that educational level was not significantly associated with PMTCT service utilization (p = 0.168). In contrast, parity was significantly associated with PMTCT utilization (p = 0.007). Exposure to PMTCT-related information was also significantly associated with PMTCT service utilization (p < 0.05). Meanwhile, waiting time for services showed no significant association with PMTCT utilization (p = 0.092). Multivariate analysis revealed that exposure to PMTCT information was the most dominant factor associated with PMTCT service utilization. In conclusion, increased exposure to PMTCT information is associated with higher utilization of PMTCT services among pregnant women. Adequate dissemination of information enhances pregnant women’s knowledge and awareness of the benefits of PMTCT as an effective strategy for preventing mother-to-child transmission of HIV.

Premature rupture of membranes (KPD) is the rupture of the membranes before there are signs of labor, and after waiting for an hour the signs of labor have not yet begun. The time from when the membranes rupture until uterine contractions occur is called premature rupture of membranes. Factors that are closely related to PROM include infection, socio-economic factors, blood type factors, smoking behavior, history of PROM, incompetent cervix and intrauterine enhancement that is high or excessively high, fetal disproportion, multigravidity, multiple pregnancies, previous history of PROM , polyhydramnios, trauma, age and parity. The danger of premature rupture of membranes is the possibility of infection in the uterus and premature birth which can increase morbidity and mortality for mother and baby. Premature rupture of membranes causes a direct connection between the outside world and the space in the uterus, making it easier for infection to occur. The aim of this study is to determine the relationship between age and parity with the incidence of premature rupture of membranes in women giving birth at Harapan Bunda Hospital, Batam City in 2023. This research design uses analytical observational with a cross sectional approach, where data is taken using secondary data with a sample size of 65 people. The processing technique uses the chi-square test. The data obtained from the results of statistical tests is with p-value for age = 0.028 and for parity p-value = 0.039. The conclusion of this research is that the majority of mothers give birth at a non-risk age (20-35) and at a parity that is not at risk (2-3). There is a relationship between the age and parity of mothers giving birth and the incidence of KPD at Harapan Bunda Hospital, Batam City in 2023. With the p-value is 0.028 for age and the p-value is 0.039 for parity so that the p-value < α (0.05).

Trace elements such as copper, zinc, selenium, and chromium play essential roles in various enzymatic reactions, antioxidant defense mechanisms, and overall metabolic regulation, making them crucial for maternal and fetal health. During pregnancy, the demand for these micronutrients increases significantly due to physiological changes and the needs of the developing fetus. Inadequate or excessive levels of these trace elements can lead to altered fetal development and may impact neonatal outcomes immediately after birth. Given the sensitive developmental window of gestation, the intrauterine environment—including micronutrient status—has been hypothesized to influence neonatal physiological parameters such as heart rate, respiratory rate, and Apgar scores, which are commonly used to assess neonatal wellbeing in the early minutes of life. This study attempts to explore the impact of maternal trace element status—specifically copper, zinc, selenium, and chromium—along with selected maternal parameters (BMI, parity, gravida) on indicators of neonatal wellbeing, including heart rate, respiratory rate, and 5-minute Apgar score. A cross-sectional study was conducted in the Delivery Room of the Obstetric Hospital in Al-Diwaniya City, Iraq, involving 50 mother-infant pairs. Data collection occurred from December 1, 2024, to February 10, 2025. Maternal blood samples were analyzed using atomic absorption spectrophotometry to determine serum concentrations of copper, zinc, selenium, and chromium. Neonatal outcomes were assessed via standard clinical evaluations: heart rate and respiratory rate were measured immediately postpartum, and Apgar scores were recorded at five minutes. Statistical analyses included Pearson correlation and multiple linear regression to assess associations between maternal factors and neonatal outcomes. Bivariate and multivariate analyses indicated limited but noteworthy associations. Maternal serum chromium levels were significantly associated with increased neonatal respiratory rate (p = 0.026), suggesting a possible stimulatory or stress-related effect.

Maternal and Child Health (MCH) remains a major challenge in Indonesia's health sector, given the high maternal and infant mortality rates, largely caused by pregnancy complications. One obstetric complication that requires special attention is Premature Rupture of Membranes (PROM), as it can increase the risk of infection in the mother and fetus and contribute to preterm birth. This study aims to analyze maternal risk factors associated with PROM in the Uteun Pulo Community Health Center (Puskesmas), Seunagan Timur District, Nagan Raya Regency, in 2025. The research method used was a retrospective survey with a quantitative approach. Data collection was conducted through a review of medical records and structured interviews. Fifty-three pregnant women with PROM participated in the study. Data analysis used a chi-square correlation test to examine the relationship between the independent variables and PROM incidence. The results showed a significant association between maternal age and PROM incidence, with a p-value of 0.023 (p < 0.05). Furthermore, parity also had a significant association with the incidence of PROM, with a p-value of 0.013 (p < 0.05). Other findings showed a significant association between maternal age and the frequency of PROM, with a p-value of 0.028 (p < 0.05). These results indicate that maternal age and previous birth history are important factors that need to be considered in PROM prevention efforts in primary healthcare. These findings are expected to inform the development of intervention strategies and education for pregnant women to minimize the risk of pregnancy complications that lead to PROM.

Giving breast milk (ASI) exclusively during the first six months of a baby's life is very important in supporting the baby's growth and development and body resilience. However, the practice of giving formula milk is still quite high and is a challenge in fulfilling exclusive breastfeeding. This study aims to determine the determining factors for giving formula milk to babies aged 0-6 months in the work environment UPT Primary Health Care Pujon. This research design uses a descriptive analytical approach with a cross-sectional method to identify factors associated with exclusive breastfeeding. The research population was all mothers who had babies with a sample of 52 respondents obtained through total sampling. Data analysis was carried out using the Chi-Square test and logistic regression to determine the most dominant factors. The research results showed that all variables had a p value > 0.05, namely age (p=0.274), education (p=0.156), occupation (p=0.384), parity (p=0.280) and socio-culture (p=0.711), so there was no significant relationship between these variables and exclusive breastfeeding. The logistic regression model was also not significant (p=0.308), indicating that there were no dominant factors influencing the practice of exclusive breastfeeding among respondents. Thus, the low coverage of exclusive breastfeeding in this study may be influenced by other factors outside the variables studied.

Anemia in pregnant women is a significant global public health issue, with a prevalence of 35.5% in 2023, according to the Global Anemia Estimates 2025 from the World Health Organization (WHO). The prevalence of anemia among reproductive-aged women is 30.7%, while it is 30.5% in non-pregnant women. This indicates that anemia is more prevalent among pregnant women compared to the general female population, highlighting the need for greater attention to this health issue. This study aims to identify and evaluate the risk factors or causes of anemia in pregnant women using an observational analytical approach. The research design employed is cross-sectional, which allows for the observation of the relationship between maternal knowledge about anemia and the occurrence of anemia in pregnant women at the same point in time. The study population consists of all pregnant women who visit the community health center (Puskesmas) for checkups. The results indicate that there is no significant relationship between parity (number of previous births) and the occurrence of anemia in pregnant women, with an Odds Ratio (OR) of 1.58. This means that women with higher parity are 1.58 times more likely to experience anemia compared to women with lower parity. However, the study found a significant relationship between maternal knowledge about anemia and the occurrence of anemia in pregnant women. Mothers with better knowledge about anemia are less likely to experience it. This study is expected to provide important information about the importance of improving maternal knowledge regarding anemia, which can contribute to the prevention and control of anemia in pregnant women. By enhancing maternal knowledge, it is hoped that the prevalence of anemia in pregnant women can be reduced, improving the overall health of both mothers and their unborn children.

Childbirth is a natural physiological process, but it is often accompanied by intense pain, especially during the first stage, the cervical dilation phase. This pain arises from uterine contractions, cervical dilation, and fetal pressure on the pelvic structures. For primiparous mothers, this experience of childbirth is a first-time experience that can cause anxiety, tension, and even trauma if not managed properly. The research design used in this study was a quasi-experimental study with a two-group pretest-posttest. The sample size in this study was 38 participants: 19 in the intervention group and 19 in the control group, using a simple random sampling technique. The data analysis used was the t-dependent and t-independent tests. The results of the study obtained the characteristics of the intervention group respondents, most of the respondents were aged 30-35 years as many as 8 people (40.1%), parity of 2 children as many as 8 people (38.5%), and education level was high school as many as 14 people (73.7%). While in the control group most of the respondents were aged 30-35 years as many as 7 people (32.8%), parity of 2 children) as many as 9 people (40.5%), and education level was high school as many as 18 people (94.7%). The intensity of pain in the intervention group before effleurage massage was an average of 6.26 and after an average of 5.74 while in the control group before massage was an average of 6.97 and after an average of 5.83. The results of the dependent t-test of pain intensity before and after effleurage massage in the intervention group obtained a P value of 0.000 and in the control group before and after massage obtained a P value of 0.006. The results of the independent t-test can be concluded that there is a significant difference after the effleurage massage method was carried out in the intervention group, namely a P value of 0.001. From the results of this study, it is known that there is an effect of the effleurage massage method on reducing the intensity of labor pain in the active phase of the first stage of labor in mothers inpartu. Therefore, it is recommended that midwives apply the effleurage massage method as an intervention to reduce pain in the care of mothers in normal labor.   Keywords: ,   

Preeclampsia is a complex illness that can cause health issues and even death for both the mother and the fetus. The three signs of preeclampsia include elevated blood pressure (up to 140/90 mmHg), proteinuria (high protein in the urine), and edema. Preeclampsia is linked to a number of characteristics, including as parity, age, education, occupation, history of hypertension, multiple pregnancies, history of diabetes mellitus, and kidney disease. The purpose of this study is to identify the variables linked to the prevalence of preeclampsia in Tidore Regional Hospital patients who are pregnant or giving birth. This study employs a case control methodology and a descriptive analytical approach. Up to 132 respondents, comprising 66 case groups and 66 control groups, were sampled by accidental sampling. Medical records of moms who had preeclampsia were used as secondary data. A p-value of 0.001 (Sig. <0.05) indicated a relationship between parity and the incidence of preeclampsia; a p-value of 0.001 (Sig. <0.05) indicated a relationship between employment and the incidence of preeclampsia; a p-value of 0.000 (Sig. <0.05) indicated a relationship between the incidence of preeclampsia and a history of diabetes mellitus and kidney disease. preeclampsia at Tidore Regional Hospital with a p-value of 0.042 (Sig. <0.05).

The 2023 Indonesian Health Survey stated that the proportion of exclusive breastfeeding in Sumatera Utara Province was quite low, namely 43.9%. The low coverage of exclusive breastfeeding is closely related to the lack of knowledge of postpartum mothers, which is a predisposing factor that encourages mothers to only give breast milk for 6 months to their babies. The purpose of this study was to determine the factors related to postpartum mothers' knowledge of exclusive breastfeeding in the Tuntungan Health Center work area, Pancur Batu Subdistrict. This study was an observational analytic study with a cross-sectional design. The sample in the study were postpartum mothers in the Tuntungan Health Center work area who met the inclusion and exclusion criteria, namely 50 people. The data collected were primary data obtained through questionnaires distributed to postpartum mothers. Bivariate analysis was carried out using the chi-square test to determine the relationship between the independent and dependent variables. Based on the study conducted, it is known that there is a relationship between age (p-value = 0.015), education (p-value = 0.026), and parity (p-value = 0.008) with postpartum mothers' knowledge of exclusive breastfeeding. There is no relationship between occupation (p-value = 0.224) and postpartum mothers' knowledge of exclusive breastfeeding. It is recommended that health workers in the Tuntungan Health Center work area, Pancur Batu Subdistrict, to improve the knowledge of postpartum mothers, especially for young mothers (<20 years) and primigravida mothers. It is also recommended that postpartum mothers improve their knowledge through various media, especially social media.

Working mothers who have babies experience obstacles in breastfeeding due to low knowledge of ASI and how to store it properly. This study aimed to determine the effect of ASI health education on ASI knowledge of working mothers. The research used a quantitative experimental approach with a one-group pretest-posttest design. The population was working mothers who breastfed babies aged 0-6 months in the Kagok Semarang health centre work area. The number of samples was 30 people. The side technique used quota sampling. Data were obtained using a questionnaire and then analyzed using descriptive statistics and the Wilcoxon Test. The majority of the characteristics of working mothers in this study were aged 26- 30 years (53.6%), parity <3 Births (73.2%), high school education (35.7%), working outside the home (64.3%) and income > UMR (67.9%). Before health education, the knowledge of ASI in working mothers was quite good (16 people or 53.3%). The knowledge of ASI in working mothers after health education was good (20 people or 66.7%). There is an influence of ASI health education on the knowledge of ASI of working mothers (Z = -3.557 and p <0.05). The conclusion is that ASI health education can increase the knowledge of breastfeeding of a working mother.

Overview: Low Birth Weight (LBW) is a significant health problem in Indonesia because it is at risk of increasing neonatal mortality and morbidity. Objective: This study aims to analyze the risk factors associated with the incidence of LBW in newborns at Prof. Dr. Margono Soekarjo Purwokerto Hospital. Research Method: The method used is an analytical observational study with a cross-sectional design. A sample of 200 mothers and babies was obtained through purposive sampling techniques. Data were collected from medical records and analyzed using the chi-square test and logistic regression. Research Results: showed that prematurity had a partial effect on LBW with a sig value of 0.000 <0.05, and showed that if the incidence of prematurity increased by one percent, assuming the value of other variables remained constant, it would increase the incidence of LBW by 2.769 percent. Variables parity, maternal age, anemia, twin pregnancy, hydramnios, PEB, Placenta Previa, KPD, prematurity, fetal pregnancy simultaneously affected LBW. Conclusion: parity, maternal age, anemia, twin pregnancy, hydramnios, PEB, Placenta Previa, KPD, prematurity, fetal pregnancy simultaneously affect LBW.

The cases of maternal mortality Bogor city in 2022 caused anemia were found to be 30.77%. The purpose the study to determine the relationship between Knowledge, Age, Parity, and History Fe tablet consumption with the incidence of anemia in pregnant women PMB Muthia, Amd.keb Cilendek Barat Bogor Barat, Bogor City in 2024. Research with quantitative approach, cross-sectional design. The sample selected using  total sampling technique. Data collected through questionnaires and medical records consisting 42 respondents. variables of knowledge, parity, age, history Fe tablet consumption, and anemia. The research data were interpreted using Chi Square. Based on the calculation results, was found that among 42 respondents, those with poor knowledge more prevalent the non-anemic group, with 8 people (100.0%), compared anemic group, with 24 people (70.6%). Based on calculation results obtained from 42 respondents, those with age and parity were at greater risk anemia group with 12 people (35.3%) compared to the non-anemia group with 0 people (0.0%). Based calculation results obtained from 42 respondents, those with a history of Fe tablet consumption had higher risk in the anemia group, with 19 people (55.9%) compared non-anemia group, with 3 people (37.5%). There relationship between parity, maternal age, and incidence anemia.

The duration of the second stage of labor is a significant factor influencing maternal and neonatal outcomes. Maternal and neonatal mortality rates remain a major global health challenge, and various risk factors, including prolonged second stage of labor, contribute to this issue. Successful childbirth is influenced by risk factors such as maternal age, parity, and body mass index (BMI). This cross-sectional study aimed to analyze the relationship between maternal age, parity, and BMI on the duration of the second stage of labor among 224 postpartum women at TPMB M in 2023. The results showed that women with advanced maternal age (<20 years or >35 years), nulliparity or grand multiparity, and underweight or obese BMI were at significantly higher risk of prolonged second stage of labor. These findings highlight the need for special attention to pregnant women with these risk factors to prevent obstetric complications. Healthcare providers are encouraged to enhance risk factor monitoring through education, screening, and comprehensive management during pregnancy.