Developing of a new guideline for improving birth experiences among Iranian women: a mixed method study protocol

Development of a modified physiological birth programme integrated into Iran's health system and its effect on maternal and neonatal outcomes: an embedded mixed-methods study protocol

INTRODUCTION

As recommended by the WHO, promotion of physiological birth is a main strategy to reduce the rate of caesarean section and achieve Sustainable Development Goals. A modified version of the physiological birth programme that may be included into the Iranian healthcare system was developed as a result of this mixed-methods research.

METHODS AND ANALYSIS

This embedded mixed-methods study had a qualitative phase that was conducted before a clinical trial. This qualitative phase was conducted via semistructured in-depth targeted interviews with the recipients and the providers of physiological birth programme services. Data analysis was performed using a conventional content analysis approach. Then, for designing the intervention, national and international guidelines of physiological birth were reviewed, and a panel of experts was convened using the Delphi method. A randomised controlled trial was used in the second phase of the research to examine the impact of the physiological birth programme's intended intervention on maternal and neonatal outcomes as well as mothers' experiences during labour. It was conducted on 252 eligible pregnant women in two intervention and control groups. Finally, the results of qualitative and quantitative phases contributed to developing a physiological birth programme which can be integrated into the Iranian health system.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.050). All participants gave their informed permission. The study's findings will be shared via the publishing of peer-reviewed articles, talks at scientific conferences and meetings with related teams.

TRIAL REGISTRATION NUMBER

Iranian Registry of Clinical Trials (IRCT20220406054438N1).

Iranian women's perception on the determinants of birth experience: a qualitative study

BACKGROUND

The prevalence of cesarean birth in Iran is very high. Having a negative childbirth experience is one of the reasons that primiparous women provide to prefer caesarean birth over a vaginal birth. This study is aimed to understand women's perspective on what determines a positive or negative birth experience for them.

METHODS

This qualitative study is a part a mixed method study that was conducted among primiparous women with a previous vaginal birth experience. The purpose of the main study was to develop a guideline based on Iranian primiparous women's birth experiences. The quantitative phase of the study was a cross-sectional study where women's childbirth experiences was measured in a survey via the Childbirth Experience Questionnaire-2. In the qualitative part of the study, women were invited for an in-depth interview via a random stratified sampling method based on their childbirth mean score (women with 10% of the upper bound score which indicated a positive birth experience and 10% of the lower bound indicating negative birth experience, n = 17). Conventional content analysis was used for data analysis.

RESULTS

We extracted three main themes: (a) "Internal control", (b) "External control", and (c) "Support". Possessing internal control, having a balanced external control to feel cared and feeling supported were the main reasons for women to feel positive about their birth experiences. Whereas, loss of internal control, imbalanced external control and unsupportive environment were related to their negative childbirth experiences.

CONCLUSION

Considering that women's sense of control, the care and support that they receive can influence their childbirth experiences, there is a need for changing maternity policies and practices to highlight the importance of a woman-centred care to create a pleasant, respectful and positive memory for primirparous women who experience normal vaginal births.

Recommendations for improving primiparous women's childbirth experience: results from a multiphase study in Iran

BACKGROUND

Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births.

METHODS/DESIGN

The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members.

RESULTS

The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique.

CONCLUSION

Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.

Development and validation of a guideline on sexual and reproductive health of breast cancer survivors in Iran: a mixed methods study protocol

BACKGROUND

Sexual and reproductive health problems significantly decrease quality of life in survivors of breast cancer. The best approach is to provide services according to evidence-based guidelines developed based on their practical context. Here, we aim to develop and validate a guideline on the sexual and reproductive health of breast cancer survivors in Iran.

METHODS

The guideline will be developed and validated using an exploratory sequential mixed methods approach in three phases: (1) describing sexual and reproductive health needs of survivors of breast cancer in Iran and the health services they receive in this regard, (2) performing a systematic review of existing guidelines, resources, and documents on the sexual and reproductive health of breast cancer survivors worldwide, and (3) developing and validating a guideline on the sexual and reproductive health of women who survived breast cancer in Iran based on the results of phases 1 and 2 through multiple steps.

DISCUSSION

A comprehensive and practical guideline on the sexual and reproductive health of breast cancer survivors in Iran will be developed which will be compatible with their specific needs and culture, considering the limited resources available. This guideline can significantly improve the quality of life in breast cancer survivors in Iran. In addition, the approach we will use here can be utilized to develop guidelines on sexual and reproductive health of female cancer survivors in general.