Background & Aim: The severe pain of labor is the important cause of fear and anxiety in pregnant women. This study has been performed to evaluate effect of education on midwives practice.

Methods & Materials: This is a quasi-experimental study. That was done 59 midwives in the labor wards of non-educational of Guilan University of Medical Sciences Hospital. Data gathered by a questioner, which its validity was done by panel of experts and reliability by test-retest. 59 midwives were chosen by quota sampling and participated in a one-day workshop. Pretest and post-test questioner completed before and after four months of education by all midwives. Data analyzed by descriptive and inferencing statistical methods with SPSS.

Results: The paired t-test results showed that midwives practice about pain relieving methods changed significantly after workshop (p<0.005). Analytical methods demonstrated that there was no significant difference between mean practice scores and demographic characteristics of midwives. Conclusion: This study showed that teaching through workshop can improve the use of pain-relieving methods by midwives in labor wards especially more simple and efficacious methods.

Background & Aim: Knowledge of nursing is necessary for caring people suffering from pain. Regarding pain management and nursing role in order to put into practice exact pain management and availing comfort, possessing knowledge and positive attitude toward nursing care in this population have an important role.

Methods & Materials: This descriptive (cross- sectional study) determines cancer nurses knowledge and attitudes regarding pain management in hospitalized patients in related wards in Tehran University of medical sciences. Total of 113 nurses (from 132 questionnaires were sent, 113 of them were completed) who work in cancer wards in Tehran University of medical science hospitals were selected by convenience sampling (accidental sampling). For data gathering, questionnaires were used. Statistical analysis was performed using 2 test, t-test and Pearson correlation coefficient. To compare results and for describing the results, descriptive analysis were used. Results:

Results indicates that knowledge and attitude of samples is in a high school (level of knowledge 76% and level of attitude 86.6%). The correlation between knowledge and attitudes is (R=0.350), (p=0.000) that means there is a direct relation between nurses knowledge and attitudes and by increasing one of them، the other will increase.

Conclusion: Some of features like level of education, taking part in continuing education, working in chemotherapy and radiotherapy ward, operating room and facing to cancer patients, influence on nurses knowledge and attitudes.

Background & Aim: Chronic illnesses, such as cancer, can cause changing in self-esteem. This study has been perform to compare the self-esteem between male and female cancer patients.

Methods & Materials: In this research 101 patients (51 women and 50 men) with different types of cancer (solid tumors and leukemia) have selected by simple sampling method. The tool for gathering data was a questionnaire, with three parts: demographic characteristics, disease characteristics, and Cooper smith self-esteem inventory. Data collection was done through interview, patient’s charts and patients self-report. The descriptive and analytic statistics have been used and the exams were “chi-2” and “Fisher”, through SPSS software.

Results: This study showed that the majority of cancer patients in male and female group have moderate level of self-esteem. There is no significant difference in self-esteem of men and women with cancer and the majority of them (84.3% women) and (%76 men) have moderate self-esteem, but noticeable difference between men and women is connected to the variables that are related to self-esteem, whereas, men’s self-esteem has not any significant meaningful relationship with demographic variables, meanwhile, variables of being under support of somebody (p=0.005) and having caregivers at home (p=0.039) have a meaningful relationship with women’s’ self-esteem. Among the diseases’ characters change or decrease in function of different parts of body has a meaningful relationship with men’s (p=0.014) and women’s (p=0.005) self-esteem. Constipation is the only other variable related to men’s’ self-esteem (p=0.071), but about women there are some variables related to the self-esteem of them consist of duration of amputation (p=0.018), anorexia (p=0.001), alopecia (p=0.027) and fatigue (p=0.021).

Conclusion: It seems that, in comparison between tow genders with cancer although the women’s self- esteem is related to more variables than men, but, recognition and specify these variables can help nurses to design an effective care-plan to meet the gender-specific needs.

Background & Aim: Patient education, one of the most important nurses responsibilities, depend on their motivation therefore, this study was performed and the purpose of the study was for determining the nurses motivating factors related to the patients education .

Methods & Materials: A descriptive cross sectional research was carried out among the nurses in the hospitals affiliated to Tehran University of medical science. Sample population was 214 nurses selected by stratified & cluster sampling. Data was collected by questioner through self reporting. The data were analyzed by SPSS computer software. Descriptive statistic and 2 Test, Fisher Exact Test, Exact Test Mont Carlo were used.

Results: Data of motivating factors categorized in 3 levels, high, moderate, low with Lickrate scale showed that in nurses’ opinion salary and payment (48%), facilities (49.5%), supervision (57.5%), have average effect on their motivation related to the patient education. Job security (68%), respect & appreciation (76%), career development (74%), work-interest (81.5%), knowledge (85.5%), professional responsibilities (90%) have much effect on their motivation related to the patient education. Statistical test showed a meaningful relation between demographic variables and motivating factors.

Conclusion: According to the findings, Job security, respect & appreciation, career development, work-interest, knowledge, professional responsibility have much effect on the motivation for patient education.

Background & Aim: Some aspects of life style in adulthood have major preventive role from osteoporosis in adult ages. This research has been done in order to determining female teenager’s life style in relation with prevention of osteoporosis.

Methods & Materials: This research was a descriptive - analytical study. In this study, 760 person of female teenage students in high schools and pre-university centers of zone 17 in Tehran city were chosen by random classified cluster sampling method. In this study, the tool for data collection was written questionnaire, and method of it was answering to questionnaire. The questionnaire had 2 parts. First part included demographic characteristics, and second part included different dimensions of lifestyle in relation with prevention of osteoporosis, such as nutrition, exercise and physical activity, habits (smoking, using weight loss food regimen and weight loss drug). The life style categorized as 3 levels unfavorable, partially favorable, and favorable. The collected information was assessed by SPSS software and descriptive and analytical statistical methods were used to reaching study objects.

Results: Results Showed nutrition, phisycal activity and exercise the highest percent of cases (51.8%, 57.7%) had undesirable lifestyle. Also 50 percent of cases had undesirable lifestyle. About habits (Smoking, using weight loss food regimen and using weight loss drug) the highest percent of cases (74.9%) had desirable lifestyle. Also there was a significant statistical relationship between life style and variables of education level (p=0.004), economical status of family (p=0.043), the birth number in family (p=0.001) and educational level of mother (p=0.005).

Conclusion: According to the results of research, lifestyle of 50% of female teenagers was undesirable. Findings of this research are attentive and need more assessment and planning by responsible people in order to omitting noted problems in lifestyle.

Background & Aim: Epilepsy as the most important chronic neurological disease affects on child and his/her family therefore it can lead to occur some stresses in family particularly in parents. This study has been done to determine ideas of parents with epileptic children about stressors and their coping with this agent in those who come to the optional therapeutic centers in Tehran.

Methods & Materials: This is a descriptive-analytical research which 400 parents with epileptic children were selected based on aim. The method of collecting data was by questionnaire for literate persons and by interview for illiterates whose research tool was questionnaire. The questionnaire was prepared in three parts (demographic information’s, stressors questions, and coping questions for parents with epileptic children. The data was collected in one stage and analyzed with SPSS software. To analyze the data, descriptive and inferential statistical methods (t-test, analyze variance) have been used.

Results: Statistical analysis showed that there is significant differences in stress between parents (p=0.001). The most percentage (86%) of fathers in comparison mothers (81.9%) have moderate level of stress and least percentage (5.4%) fathers and (4.4%) of mothers have low level of stress. The level of stress in parents showed significant correlation with personal variables. Most percentage (69%) of fathers and mothers (66.1%) have low-moderate level of coping and it has significant correlation with some personal variables. The analyze variance test showed that there was significant and converse relationship between stress and coping in parents with epileptic children and increasing stress lead to decrease coping. Conclusion: The results of this study have been shown that the stress in father of epileptic children is more that mothers however there is no significant differences in the level of coping.

Background & Aim: Nurses have the major role at care continuity and health promotion. They frequently affect total productivity in a organization. However, the nurses believe that due to several barriers they have not desire productivity, therefore the health care have been left at level of quality. The aim of this research are assessing nurses&apos view about productivity and role of human resource on it.

Methods & Materials: This study has been done based on grounded theory method. Open interviews has been used for gathering of data. Sampling was purposive in beginning study but so that study was proceeding and categories were completed, it changes to theoretic sampling. Constant comparative analysis was method of data analyses.

Results: Essential themes emerged from the data in human resource category. These are: systemic calculating number of staff, accurate staff select and use criteria for them, provide adequate staff from various categories in total year&aposs day, accept patient when as coordinate to in charge nurse and well communication. These make necessary groundwork for productivity. Then accidents that emerged from inappropriate quantity and quality of human resource will be decreased. These enhance nursing productivity the biggest group of health care services. Model of Productivity and human resource effects on it’s, from nurses&apos view, has concluded of this research.

Conclusion: In nurses&apos view that participates in this research, human resource can affect on productivity process and improve it, then it lead to develop quality care- health care vision and goal.

Background & Aim: Fatigue is a premature symptom in the patients suffering from chronic obstructive pulmonary disease. This study was conducted to investigate the effect of breathing exercises on fatigue level of COPD patients.

Methods & Materials: This clinical trial is a semi-experimental study. 60 patients suffering COPD which are bedridden at, Tehran university of Medical Sciences hospital wards which have been sampled simply and divided into experience and control group randomly. Data gathering is done by interview and data registration from the files. The data gathering tools are questionnaires, fatigue severity scale (FSS) and respiratory exercise usage checklist. The questionnaire includes to sections of demographic characteristics and patient info. The exercises check list is scaled from 0 to 40 in the way that the maximum amount of usage in 10 days, for 4 daily sessions would be 40 and for the case of usage 0 score is assigned. Fatigue severity scale includes 9 questions with visual diagrams scaled from 0 (Lack of fatigue) to 4 (server fatigue). The gathered data is analysis using SPSS software and the descriptive and deductive statistical methods (Tisuchi, Kai2 and Pearson correlation exam) are used to achieve the research goals. Results: The results show that the average fatigue intensity for the experience group is 40.916 with the standard deviation of 14.4 and for the control group is 52.20 with 8.539 standard deviation after the study and statistical T-exam (p=0.001) indicated that there is a significant difference in fatigue severity between experience and control groups after the study. The findings also showed that the average fatigue severity before (55.766) and after (40.166) using the respiratory exercises in the experience group (p<.001) has enormous difference. While the average fatigue severity in the control group (p=0.002) before (54.166) and after (52.200) the study has a ting difference. Regarding the correlation of using respiratory exercises and the changes in fatigue severity, the Pearson statistical exam showed that there is a significant reverse correlation between using respiratory exercises and fatigue severity (r=-0.593, p=0.001).

Conclusion: Based on the research findings it can be concluded that using respiratory exercises is effective in reducing the fatigue in the patients with COPD that also confirms the research assumption and the more the respiratory exercises are used the less is the amount of fatigue in the interfered samples.

Background & Aim: Pain is the most common compliant of the patients and its reduction or elimination had been always demand of most patients and health care providers. Various methods have been proposed to pain, which we can mention to attention deviation strategies. The study aims to compare these strategies and choose the most effective one method for control the pain.

Methods & Materials: The research is a quasi-experimental one by which 230 students of one of the universities of Tehran were called out and participated in the test of tolerance to cold pressure induced pain. 120 participants that their tolerance were a point of standard deviation lower than the whole group were selected and were randomly set in 4 groups (3 experimental groups and 1 control group). These groups composed of 30 people were instructed a method of attention deviation (like desirable imagery, application of concentration point, counting down). The participation’s in control and experimental groups were tested by cold pressure and data were analyzed by SPSS through descriptive indices and One-Way Analysis of Variance (ANOVA).

Results: Results show that the average score of pain toleration in experimental groups were significantly higher than control group (p<.001). Meanwhile the average point of pain toleration in desirable imagery group were significantly higher than the average point of application of concentration point, counting down groups (p<.001).

Conclusion: The attention deviation strategies were effective in increasing of the experimental pain toleration.

Background & Aim: Many of the studies show benefit effects of exercise on mother and fetus during pregnancy. The aims of this research include of assessment of effects aerobic exercise on three factors: pregnancy age, birth weight and apgar score.

Methods & Materials: During an experimental study, 80 pregnant women who referred to prenatal clinics in zone of 17 of Tehran were selected and divided in two equal groups. Inclusion criteria included, 18-35 years old, 18 weeks of pregnancy, second gravidity, without history of medical illness and exercise before pregnancy. In case group samples were under 15-30 minutes aerobic exercises with 50-70% Vo2 max 3 days a week for 8 weeks. Data were analyzed by SPSS version 10.5 soft ware and t test and 2 were used for statistical analysis.

Results: Total 80 pregnant women enrolled in two groups. There were no statistically significant differences between cases and control in demographic factors. The most of cases were in 40 weeks group and more and the most of control were in 38-40 weeks however, there are no statistically significant differences between cases and control. The most of infants of cases and control mothers (60% and 70%, respectively) were in 2500g-3500g group but no statistically significant differences between cases and control. There are statistically significant differences between cases and control in 5 minute apgar score (p=0.01).

Conclusion: In overall, the results show aerobic exercise improve 5 minute apgar score, but do not show significant effects on pregnancy age and birth weight.

Background & Aim: Osteoporosis is a metabolic disease which is the result of gradual destruction of bone mass and its most serious and frequent complication is hip fracture. Because adolescent females are the high risk group of affecting this disease, the purpose of this study was to assay female students’ knowledge’s about osteoporosis and its risk factors.

Methods & Materials: A cross-sectional study with a 31-item questionnaire was used in this research. A convenience sample of 1000 adolescents in grade 1-3 who attended at 6 high schools participated in this study. Using SPSS software, the data were analyzed by chi2 and T tests.

Results: According to 22 questions about knowledge, sufficient knowledge of students was estimated 40.8%. Among 10 factors related to the family, only correlation between father occupation and knowledge was significant statically (p=0.049). Knowledge was higher in independent- medicine versus dependent medicine occupations.

Conclusion: Overall, the knowledge of these assayed female students about this disease and its risk factors including sex, race, smoking, sun exposure, exercise, calcium- rich foods and menopause and its complications was limited.

Background & Aim: Labor pain is one of the most intensive type of pain and regarding its control still is a problem in many countries. The aim of this study is to investigate the effect of transcendental meditation on pain and length of active phase of labor in primiparous women.

Methods & Materials: This study configured as a semi-experimental clinical trial work. Samples was selected by convenient sampling method and contained as 90 primiparous women’s (45 case and 45 control) whom refer to clinic and delivery room in Fatemieh Hospital of Hamadan. Samples were divided into two random group and accomplished to experience and observation transcendental meditation method used for training pregnant woman within third trimester of pregnancy (28th-30th week) and performed by them for two time a day during 10 to 15 minutes. The case and control groups were matched according their age, education and occupation case and control group were confined to bed when they were in the beginning of active phase (3-4 cm of dilatation). Collecting of data, questionnaire information of biophysical and other equipment for recording biophysical developments and other McGill instrument was used to record severity of pain. Reliability and validity instrument in the prior researches have been test. The length of active phase was measured over maternal and recorded.

Results: The results of this study showed that there is significant differences in the level of pain at the beginning of first, second and third hour of active phase of labor in case and control group (p<0.001). Also, the length of active phase of labor showed significant difference between case and control group (p<0.001). Although, the body temperature and systolic blood pressure in two group showed no significant differences but there was meaningful differences in diastolic blood pressure (p<0.029), however this differences was in normal range. Regard to rate of breathing significant differences has been shown in case and control group (p<0.006).

Conclusion: Transcendental meditation in participated samples over this research among the mothers agony experience group has less pain within all active phase hours.

Background & Aim: Pain is one of the important complication of chronic diseases such as cancer. Purpose of this study is to investigation of two non-pharmacological methods, progressive muscle relaxation and music, on pain relief in patients suffer from cancer.

Methods & Materials: This research is a intervention clinical trial which was done in a hospital affiliated to Tehran University of Medical Sciences. In this study, 100 cancerous patients that have inclusion criteria were selected by simple sampling method. The participants into two groups allocated, 50 patients in progressive muscle relaxation, and 50 patients in music group. Data collection tools were questionnaire, pain level recorded sheet, taps with headphone (is produced by Sony company) and music box including light music consist of classical, mild and Iranian traditional music. Questionnaire was designed in two parts, demographically characteristics and disease characteristics. Data were collected by interview and patient self report. After adequate education to two groups, asked them to perform that method 30minet per day until 3 days. Then, pain level, at previous 24 hours until 3 days were assessed and recorded in related sheet. Analysis of data were analyzed by SPSS software, inferential and descriptive statistics such as Mann Whitney, chi Square, Fisher’s exact test, and Friedman.

Results: The finding of research showed in both relaxation and music groups there were significant differences in pain level before and after intervention (p<.001). Also there were significant differences between two groups in pain level (p=0.016). It means that pain relief in relaxation group was more significant.

Conclusion: According to the findings of this research, although both progressive muscle relaxation and music are effective and decreasing of pain level but progressive muscle relaxation is more effective than music.

Background & Aim: Postpartum depression is mood disorder that affected 10-15% of women during 6 months after delivery. This study was designed to investigate preventive effect of supportive activities during prenatal on postpartum depression.

Methods & Materials: This research is clinical trial study and the samples were 440 pregnant women in Lahijan and Astanea in eastern of Gilan .The sampling was simple randomization for 2 groups. One group presented in education classes and others received current prenatal care. Between 4 to 8 weeks after delivery their Beck depression inventory (BDI) score was evaluated among two groups. Data analysis has been done by SPSS statistical software.

Results: Prevalence depression (cases who have Beck score more than 16) in study group was 6.5% versus 18.6% in control group. Mean BDI score in study group was 7.08 versus 8.69.

Conclusion: Participated to education classes during pregnancy decrease the postpartum depression.

Background & Aim: Fatigue is a significant problem during pregnancy that has rarely been studied, and may increase the number of caesarean deliveries and preterm births. Reflexology can be utilized for decrease of fatigue. Therefore this study was aimed to identify the effect of sole reflexology on pregnant women’s fatigue severity.

Methods & Materials: This research was a clinical trail study using a pre-post test design. The subjects consisted of 74 pregnant women referred to treatment health centers of Ramsar city, with 36 and 38 cases in the test and control group respectively. Sole reflexology was preformed for 30 minutes, twice a week through five weeks, in the test group. To evaluate the effect of sole reflexology, the score of fatigue was measured before and after the experiment in both groups. The instruments used included: The sample selection form, demographic data form and fatigue severity questionnaire. The collected date was analyzed by chi-square, t-test, and paired t-test Pearson correlation coefficients.

Results: There was a statistically significant decrease in fatigue in the test group compared to the control group, after reflexology. (p=0.0001). In addition there was significant negative relationship between score of fatigue and social support (r=-0.46, p=0.002) and also score of fatigue in persons that received ferrous sulfate significantly lower than others. (p<0.000).

Conclusion: According to the results of this study It is suggested that sole reflexology might have beneficial effects on reducing fatigue in pregnant women, and can be recommended as a nursing intervention program for this persons.

Background & Aim: Sleep is an important physiological process that has deep effects on psychological and physical health. This study carried out to investigate the association between quality of sleep and health-related quality of life in nurses.

Methods & Materials: In this cross sectional and descriptive-analytic study, 127 nurses in Imam Hossein Hospital of Shahroud, Iran, during February and March 2006 were chosen enumeration and then their sleep quality and their quality of life in eight dimensions were measured with using Pittsburgh sleep quality index (PSQI) and 12-item short form health survey (SF-12) questionnaire and were compared. The data were analyzed using SPSS 11.5 software.

Results: Upon to the results of this study, 25.2%, 70.9% and 3.9% of cases were working on morning shift, circulator shift and afternoon/night shifts respectively. Mean of time that they spend in bed were estimated 30.2 minute and 2.1% of subjects declare they get to sleep more than 30 minutes after going to bed. Mean of gotten up time in the morning in was at 6 and 58% of them described that they wakeup 1 hour earlier to anticipation time. According to the results, 35.5% of subjects have taken medicine (prescribed or "over the counter") to help them sleep. Spearman correlation coefficient test revealed a significant correlation (p<0.05) between the mean of Sleep Quality score and the mean of quality of life score in all dimensions in subjects.

Conclusion: According to the results, quality of sleep is poor in majority of nurses and significantly has decreased their quality of life in different aspects, especially in general health, mental health and physical pain.

Background & Aim: Adolescent is a unique period during the life cycle. Knowing about the suitable nutrition in this period would prevent from a lot of diseases related to the nutrition during the adulthood. But unfortunately in recent decades we have observed having unsuitable snaking in adolescents. This study aimed to determine the quality of snaking in adolescents 12-18 years old in one of district of Tehran, Iran.

Methods & Materials: This study is a descriptive cross sectional research with the purpose of determining the quality of snaking in adolescents 12-18years old at 17 districts in Tehran city. The samples were 907 students that including the Iranian girls and boys who were 12-18 years old and educating in one of the guidance school or high schools of the district 17 in Tehran city. The instrument was a questionnaire and interview the data were analyzed by SPSS software.

Results: The results showed that majority of students 35.1% were 14-16 years old, 52.8% were boys, 26.1% were educating in the first year of high school. 71/5% had 1-3 sisters or brothers and also the majority of students had natural BMI, 28% were having fried potato and cheese puff over than moderate level as snaking 46% were having snaking daily. Less than half of the studied cases 46.7% believe that having snaking is necessary 56.9% had sometimes snaking. Chi2 test and p<0.05 showed a significant relationship between some of demographic variables with snaking in adolescents.

Conclusion: The result showed that type, time and number of snaking were not suitable and it is necessary to teach the students and their parents more about matter.

Background & Aim: Pain control in newborns is one of the important tasks, which produced many controversies in pediatric medicine. Nowadays, it is proposed the usage of non-pharmacologic pain control methods. This study has been done to investigate the effect of breast feeding on pain control in newborns.

Methods & Materials: A clinical trial was designed to evaluate analgesic effect of breast-feeding during injection of hepatitis B vaccine. 130 newborns had been referred for hepatitis B vaccination, were selected from Mirza Kochak Khan Hospital, Tehran, Iran. After describing the procedure was described the testimonial was took from parents. They were divided randomly in tow groups. In cases group, feeding was begun two minutes before injection and continued for 45 seconds. In the control group injection was made without breast feeding. Pain assessment was performed with Douler Aigue Nouveaune (DAN) scale.

Results: In the case group 35.4% of newborns got 4 points and no one got more than 7 points according to DAN scale. In contrast the control group 32.4% got 8 points or more and no one got less than 3 points. The mean of pain severity in case group was 3.5 and in control group was 6.7 and it show significant difference according to Mann-Whitney U test (p<0.0001).

Conclusion: This study shows that breast-feeding can significantly reduce pain in newborns. Therefore, we suggest this simple method generally for all painful procedure to prevent the development of possible permanent psychological effects in newborns.

Background & Aim: The main aim of performance appraisal is aid to staff development and increasing job motivation. Outcomes of performance appraisal consider as a determining indicators of the amount of success in achieving the mentioned aims. The aim of this study is to determine the employed nurses’ views regarding the performance appraisal&aposs outcomes and its relation with job motivation in medical-surgical wards of affiliated hospitals of Tehran University of Medical Sciences.

Methods & Materials: This investigation is a descriptive correlational study. The sample size was 120 of employed nurses in medical-surgical units in Tehran University of Medical Science that was selected by cluster sampling. The data was collected by questionnaire. Descriptive statistics, t-test and Pearson’s correlation coefficient were used for analysis.

Results: Perception of the most samples was almost positive (65%) about performance appraisal’s outcomes. They believed that the rate of the job motivation in surveyed units was low. There was a statistical significance relationship between performance improvement as one of the outcomes of the performance appraisal and job motivation (p<0.05).

Conclusion: Aiding to nurses performance improvement with using of performance appraisal was the only factor that was correlate with the job motivation in comparison with the other expectances of performance appraisal.

Background & Aim: Because of importance of communication and its defects which has been observed in communication with clients, this study has been planned and done with the aim of investigation of usage of’ communication skills by midwives and its relation to client’s satisfaction.

Methods & Materials: In a correlational study 50 midwives and 400 clients were investigated. Data collection method included observing midwife- client encounter using a checklist and interviewing clients to fill out satisfaction questionnaire. Descriptive and inferential statistics included chi- square test, fisher’s exact test and Pearson correlation (p<0/05) were used for data analysis.

Results: The results of this study showed that midwives’ communication skills (verbal and non- verbal) was undesirable (62% and 56%). There was no relation between demographic variables and midwives’ communication skills application. Just there was a relation between marital status and non-verbal communication skills application. Also clients’ satisfaction with midwives’ verbal and non-verbal communication skills (50% and 48/4%) was related meaningfully to midwives’ communication skills application. There was a relation between clients’ satisfaction and their age, educational status service they needed.

Conclusion: According to undesirable usage of communication skills by midwives, administering interim training programs for midwives is recommended. Also it seems better to include communication skills training to midwifery curriculum.