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).

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.

Women's experiences with implementation of the physiologic birth program in Iran: a qualitative content analysis study

Introduction

Increased rate of caesarean section (CS) without medical indication is a global concern. According to the guidelines of the World Health Organization (WHO), the physiologic birth program is one of the strategies for reducing the rate of unnecessary caesarean sections. The aim of this study is to explain women's experiences with the implementation of the physiologic birth program in Iran.

Materials and methods

This study is a part of a mixed-method study involving 15 targeted semi-structured interviews individually conducted with women attending physiologic birth classes between January 2022 and June 2022. Interviews continued until data saturation was achieved. Data were analyzed using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman, using MAXQDA10 software.

Results

Analysis of the findings of the study led to the emergence of 2 themes, 4 categories, and 10 subcategories. The first theme was the positive experiences of the women ("satisfaction with pregnancy" and "making the childbirth process pleasant"), and the second theme was their negative experiences with physiologic birth ("challenges and limitation of physiologic birth program" and "lack of high-quality obstetric services in the public health system").

Conclusion

The results of this study showed that childbirth preparation classes reduced women's fear and stress and enhanced their positive attitude toward vaginal delivery by preparing them for childbirth. Also, effective communication with midwives and their support along with efficient implementation of physiologic birth techniques led to successful pain management and satisfaction with the birth process. Policymakers should implement strategies to remove limitations and make this program accessible to all women.

Analysing the HERV-K env, np9, rec and gag expression in cervical tissues

Cervical cancer is considered to be the fourth common cancer. It is assumed that numerous risk factors, especially infectious ones, can have a detrimental effect on cervical cancer. In this study, we evaluated the expression of Herv-K env, np9, rec and gag in cervical tissues. After RNA extraction and cDNA sensitizing of 12 cervical cancer tissues and CIN3, 51 CIN1,2 and 18 normal ones, Herv-K env, np9, rec and gag were assessed using quantitative real-time PCR analysis. There was a decrease in the level of HERV-K env expression in cervical cancer and CIN 1-3 in compression with normal tissues. Cervical cancer and CIN3 indicated the most increase in expression. Meanwhile, we observed an increase in gag and rec expression in CIN 1,2; although cervical cancer and CIN 3 had a decrease in rec and gag expression, we did not report any changes in np expression. In conclusion, given the relationship between HERV-associated genes and cervical cancer, our study suggests that these genes can be useful for cancer diagnosis. However, further investigations are needed to provide a better perspective about the effectiveness of these genes in the diagnostic strategies of gastrointestinal cancer. These results are just an observation that could open a wider investigation to test the correlation between the expression of these genes and cervical cancer.

Sexual dysfunction and related factors in pregnancy and postpartum: a systematic review and meta-analysis protocol

BACKGROUND

Sexual dysfunction refers to a chain of psychiatric, individual, and couple's experiences that manifests itself as a dysfunction in sexual desire, sexual arousal, orgasm, and pain during intercourse. The aim of this systematic review will be to assess the sexual dysfunction and determine the relevant factors to sexual dysfunction during pregnancy and postpartum.

METHODS AND ANALYSIS

All observational studies, including descriptive, descriptive-analytic, case-control, and cohort studies published between 1990 and 2019, will be included in the study. Review articles, case studies, case reports, letter to editors, pilot studies, and editorial will be excluded from the study. The search will be conducted in the Cochrane Central Register, MEDLINE, Google Scholar, EMBASE, ProQuest, Scopus, WOS, and CINAHL databases. Eligible studies should assess at least one of the sexual dysfunction symptoms in pregnant women or in the first year postpartum. Quality assessment of studies will be performed by two authors independently based on the NOS checklist. This checklist is designed to assess the quality of observational studies. Data will be analyzed using Stata software ver. 11. Considering that the index investigated in the present study will be the level of sexual disorder, standard error will be calculated for each study using binomial distribution. The heterogeneity level will be investigated using Cochran's Q statistic and I2 index in a chi-square test at a significance level of 1.1. Predictable limitations of this study included a small number and unacceptable quality of studies.

DISCUSSION

This systematic review addresses the factors associated with sexual dysfunction during pregnancy and postpartum. Considering the high prevalence of sexual dysfunction among women, the treatment of this problem has been highly sought after by the World Health Organization in recent years. The results of this study can help discover new strategies by introducing factors affecting women's sexual dysfunction, thereby eliminating or diminishing these factors, and play an important role in improving the quality of life of women during pregnancy and postpartum periods.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018083554.

Etiology and Risk Factors Associated With Infertility

Objectives: Infertility is one of the important complications in gynecology and the aim of the present study was to investigate the etiology and risk factors associated with infertility in the southern region of Iran. Materials and Methods: This cross-sectional study was conducted in infertility centers of Hormozgan University of Medical Science (HUMS). Totally, 250 infertile couples were included. The variables including socio-demographic characteristics, smoking, body mass index (BMI), and infertility status (e.g., type of fertility, duration, etc.) were assessed by a self-administered and validated questionnaire. Data analysis was carried out using SPSS version 22.0. Results: The most common causes of male and female infertility were varicocele (49.4%) and ovulation disorders (57.5%), respectively. There was a significant association between female factor infertility and level of education, age of women, women’s age at marriage, number of abortions, alcohol consumption, presence of an underlying disease, and BMI (P<0.005). There was also a significant relationship between male factor infertility and men’s job, addiction, smoking, and presence of an underlying disease (P<0.005). Conclusions: Considering various risk factors for infertility, an important step forward can be taken towards reducing the incidence of these risk factors by providing different education classes during pre-marriage, pre-partum, pregnancy and postpartum periods so as to inform couples of controllable risk factors.

Sexual Dysfunction and its Associated Factors After Delivery: Longitudinal Study in Iranian Women

Introduction

Considering physical and emotional changes affecting women's sexual function in postpartum period.

Aim

This study was conducted to determine the sexual dysfunction and postpartum-related factors in Bandar Abbas women in 2016.

Material and Methods

This analytical cross-sectional study used systematic random sampling on 432 postpartum women referred to Bandar Abbas Healthcare Centers. Data were collected by Demographic and Obstetrics Questionnaire and Female Sexual Function Index (FSFI) Questionnaire through interview and were analyzed by using SPSS ver.22 method.

Results

The overall rate of sexual dysfunction was reported 85.95%. The most common postpartum sexual dysfunction was pain sexual dysfunction during sexual intercourse. The mean score of all types of sexual dysfunction increased over time after delivery except sexual satisfaction so that the mean score of sexual satisfaction did not show significant differences over time. There was a significant relationship between sexual dysfunction with factors such as duration of marriage (p< 0.001), number of children (p<0.001), familial relationship (p=0.028), episiotomy status (P=0.002) and contraceptive method (p=0.001).

Conclusion

Considering the high prevalence of sexual disorders in this study, healthcare systems need to pay more attention to this area. In order to promote the health status of the family and ultimate of the society, attention to sexual health as well as the early diagnosis and treatment of sexual dysfunction of couples are important, especially during pregnancy and after childbirth.

The Effect of Education Program of the Couples Based on the BASNEF Model on Spousal Support and Mental Health of Pregnant Women

Pregnancy is a natural physiological phenomenon while during pregnancy women are exposed to physical and mental changes which can affect their health and fetus. This study aimed to study the effect of young couples programs based on the BASNEF model on the mental health spouse support of pregnant women in 2014 years. This study was a quasi-experimental study. Statistical population was selected including 125 couples who referred to health centers of Hormozgan University of Medical Sciences. Centers were also selected through random cluster among health centers of Hormozgan and 2 centers were randomly assigned for implementation of intervention and 2 centers were selected as control. Training intervention was implemented on the basis of the BASNEF model which includes young couples training as face to face for four sessions of 60 minutes at health centers. 4 weeks after completing the training, post-test was performed. Instruments used in this study include 3 questionnaires: demographic information, BASNEF Model, spousal support, mental health assessment questionnaire, which was completed before and 4 weeks after the intervention in both intervention and control groups. Data was extracted and was analyzed using SPSS21 software. Average of knowledge, attitude, enabling factors, subjective norms, behavior in the intervention group showed significant differences than the control group (P <0.001). The spouses support and Mental health scores in the intervention group showed no significant difference than the control group (P <0.001). The programmed trainings using health education model be used instead of education. Educating young couples be used instead of individual care of pregnant women and also help to promote family health with the presence of their wives in prenatal care and applied proper education.