Objective To investigate the effect of midwife-led doula accompaniment combined with painless delivery on selfefficacy and pregnancy outcome in primiparous women. Methods A total of 94 primiparous women who delivered in the Delivery Department of a hospital in Zhumadian city from June 2019 to June 2021 were selected as subjects. They were assigned to a control group（n=47） and an observation group（n=47） using the random number table method. The control group received routine interventions

while the observation group midwife-led doula accompaniment combined with painless delivery intervention on basis of the routine intervention

and both groups received interventions until the end of labor. The scores of the General Self-Efficacy Scale（GSES）

Self-Rating Anxiety Scale（SAS） and Self-Rating Depression Scale（SDS） were compared between the two groups before and after the intervention. The rates of natural labor

vaginal midwifery and cesarean delivery were compared between the two groups. Results Before the intervention

there was no significant difference in GSES

SAS and SDS scores between the two groups（P>0.05）. After the intervention

the GSES scores in the two groups were higher than those before the intervention

and the observation group was higher than the control group

with statistical significance（P<0.05）. After the intervention

the SAS and SDS scores in the two groups were lower than those before the intervention

and the observation group was lower than the control group

with statistical significance（P <0.05）. The natural labor rate in the observation group was higher than that in the control group

and the rates of vaginal midwifery and cesarean section were lower than those in the control group

with statistical significance（P<0.05）. Conclusion Midwife-led doula accompaniment combined with painless delivery demonstrates good effects in primipara. It can not only improve primipara’s self-efficacy

and reduce their negative emotions

but also help to increase the natural labor rate

improve pregnancy outcomes

and promote maternal postpartum rehabilitation. These benefits justify a wider application of this technique.