Experiences of health providers regarding implementation of the physiologic birth program in Iran: A qualitative content analysis

INTRODUCTION

The rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran.

METHODS

This study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software.

RESULTS

Two main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation.

CONCLUSIONS

The experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.

Factors that enhance midwifery students' learning and development of self-efficacy in clinical placement: A systematic qualitative review

AIM

To conduct a systematic review and synthesis of qualitative studies to explore the significant factors that enhance midwifery students' learning experiences and development of self-efficacy in clinical placement.

BACKGROUND

Midwifery education programs leading to registration as a midwife require students to achieve academic, clinical, and professional competence. Clinical placement comprises a significant part of the program as students work and are assessed under the direct supervision of the Registered Midwife or preceptor. This learning and teaching partnership aims to enable the transfer of knowledge, skills, and behavior, i.e., competence, while providing the opportunity for students to become socialized into the midwifery practice culture. Against this background, characterized by the shortage of midwives, declining fertility rates, and a stressful environment, students learn to become a midwife and develop self-efficacy. Self-efficacy is the belief in one's ability to master challenges, which is described as a component in learning theories. There seems to be a need to identify factors that contribute to this development.

DESIGN

A qualitative systematic literature review.

METHOD

A systematic database search was conducted to identify primary peer reviewed qualitative literature published between 2000 and 2021 that has explored what enhances midwifery students' learning during their clinical placement. The databases searched included CINAHL (EBSCO), Medline (Ovid), Embase (Ovid), PsycINFO (Ovid), JBI Joanna Briggs Institute (Ovid), SveMed+ , and Web of Science. The search yielded a total of 354 results, of which 22 met the inclusion criteria. The relevant findings from the 22 studies were thematically analyzed and presented in the results.

RESULTS

The analysis revealed two descriptive themes - 'A nurturing relationship' and 'Predictability in the learning process, contextual factors. In addition, one analytic theme emerged - 'Gaining access to and belonging in an enabling educational and working culture'.

CONCLUSION

The relationship with the preceptor is a prerequisite for midwife students learning process and achievement of self-efficacy. A learning culture appears to be the fertile ground in which midwife students thrive and where they develop the self-efficacy needed to meet the demands of clinical placement.

Factors Associated with the Behavior of Men who Have Sex with Men in the Prevention of Human Immunodeficiency Virus Transmission

Background: The prevalence of HIV/AIDS transmission caused by the behavior of men who have sex with men (MSM) is still a concern. The purpose of this study was to determine the factors associated with MSM behavior in relation to the prevention of HIV transmission. Methods: This study used a cross-sectional design. The total sample was 176 respondents determined using consecutive sampling technique. The variables consist of demographic data, knowledge, attitude, beliefs, the accessibility of the health facilities, health-related skills, peer support, health care provider support and the prevention behavior concerning HIV transmission. The data was obtained using a questionnaire and it was analyzed using Chi-square and ordinal logistic regression. Results: From the sample of 176 MSM, the behavior of the prevention of HIV transmission was 43.75%, which is a moderate level. Through ordinal logistic regression, we found that knowledge [OR:1.171, CI: 0.414-1.929] and peer support [OR: 1.902, CI: 0.721, 3.082] are more likely to prevent HIV transmission. Conclusion: Knowledge and peer support are known to be very important factors concerning the behavior engaged in the prevention of HIV transmission. Increasing the level of knowledge and increasing the youth networks in the form of groups as a form of support can be promoted by nurses, health workers, and the community in order to prevent HIV transmission.

Women's perception of continuity of team midwifery care in Iran: a qualitative content analysis

Background

Understanding the pregnant women’s perception of continuity of team midwifery care is necessary for introducing and implementing this model of midwife-led care in the Iranian maternity services. This qualitative study aims to explore women’s perception of continuity of team midwifery care in Iran.

Methods

This research is a qualitative study conducted in Iran to explore women’s perception of continuity of team midwifery care during pregnancy, birth and postpartum from October 2019 to August 2020. Fifteen semi-structured interviews were conducted with women individually in private midwifery clinic through a purposive sampling method. Interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis.

Results

From the data analysis, two themes, four main categories, and nine subcategories emerged. The themes were “Maternal empowerment” and “Mother’s satisfaction during the transition from pregnancy to motherhood”. The first theme included two categories of improving self-efficacy during antenatal education classes and the effective midwife-mother interaction. The second theme composed of two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood.

Conclusion

Findings of this qualitative study highlight the effectiveness of continuity of team midwifery model of care for promoting empowerment and satisfaction in women during pregnancy, birth and postpartum. The results of this study could pave the way for developing, introducing and implementing the midwife-led continuity models of care in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03666-z.

Students' understanding of "Women-Centred Care Philosophy" in midwifery care through Continuity of Care (CoC) learning model: a quasi-experimental study

BACKGROUND

The philosophy of midwifery education is based on the 'Women-centred care' model, which provides holistic care to women. Continuity of care (CoC) is integral to the concept of holistic women-centred care and fundamental to midwifery practice. The objective of this study was to determine any differences in students' understanding of midwifery care philosophy between students who underwent the CoC learning model and those who underwent the fragmented care learning model.

METHOD

We used a quasi-experiment design. This study was conducted by all final year midwifery students at two schools of midwifery in Indonesia. Fifty four students from one school attended 6 months of clinical training using the CoC learning model. The control group was comprised of 52 students from the other school. These students used the conventional clinical training model (the fragmented care learning model). The independent T-test using SPSS was used to analyse the differences between the two groups of students in terms of understanding midwifey care philosophy in five aspects (personalized, holistic, partnership, collaborative, and evidence-based care).

RESULTS

There were no significant differences between the groups before interventon. There were significant differences between the two groups after clinical training (p < 0.01). The mean post-clinical score of students using all five aspects of the CoC clinical learning model (15.96) was higher than that of the students in the control group (10.65). The CoC clinical learning model was shown to be a unique learning opportunity for students to understand the philosophy of midwifery. Being aligned with midwifery patients and developing effective relationships with them offered the students a unique view of midwifery practice. This also promoted an increased understanding of the philosophy of women-centred care. Zero maternal mortality rate was found in the experiment group.

CONCLUSION

The results of this study suggest that clinical trainingwith a CoC learning model is more likely to increase students' understanding of midwifery care philosophy. This in turn improves the quality ofclinical care, thereby enhancing overall health benefits for women.

'It's a good thing…': Women's views on their continuity experiences with midwifery students from one Australian region

BACKGROUND

midwifery relationships, especially ones developed over time, are viewed and valued as practical and political health interventions that increase the likelihood of good health for women and infants and assist with health challenges. Thus the continuity relationships with women required for each Bachelor of Midwifery student are used, not only to expand students' learning but also, in a fragmented maternity care system, to provide opportunities for women to experience the care of a known person through their pregnancy, labour and early parenting time.

AIM OF THE STUDY

we sought understandings of women's experiences of their continuity relationships with midwifery students.

METHOD

a survey was posted to all women (n=1008) who had agreed to continuity in the first years of our undergraduate program 2009-2011. We analysed 354 completed surveys (34% response rate). SPSS was used for quantitative data and content analysis identified themes expressed in the qualitative responses from a selected sub-set of 27 participants. Ethical approval was obtained from the authors' institution and research funding from the local registration board.

FINDINGS

women's satisfaction of being with a student in a continuity relationship was high. On a scale from one (not at all satisfied) to 10 (extremely satisfied), the mean score was 8.88. The women, more than half of whom received standard maternity care, stated they valued the opportunity for a constant presence across their childbearing experience and will recommend student continuity to their friends.

CONCLUSIONS AND IMPLICATIONS

this study shows that our curriculum emphasis on continuity is valued by women. Pairing a woman and a student gives women a relationship with a named person in the maternity health field that provides valued extras: care, time, patience, effort, information, advocacy, support and kindness. It raises the profile of midwifery in the community, especially the profile of continuity of midwifery care for women in standard models of care. It increases communication for and with women in a variety of useful and desirable ways and it allows an opportunity for women to contribute to students' learning. It also provides the university sector a chance to value and privilege the continuity of midwifery relationship.

The feasibility of caseload midwifery in rural Australia: a literature review

BACKGROUND

Caseload midwifery is a continuity of care(r) model being implemented in an increasing number of Australian maternity settings. Question for review: is caseload midwifery a feasible model for introducing into the rural Australian context?

METHOD

Integrative literature review.

FINDINGS

Four main categories were identified and these include the evidence for caseload midwifery; applicability to the rural context; experiences of registered and student midwives and implementation of caseload midwifery models.

CONCLUSION

There is evidence to support caseload midwifery and its implementation in the rural setting. However, literature to date is limited by small participant size and possible selection bias. Further research, including rural midwives' expectations and experience of caseload midwifery may lead to improved sustainability of midwifery care for rural Australian women.