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Background & Aim: Hypothermia is a main side effect during surgery in which blood pressure, heart rate, intra cranial pressure, oxygen consumption, pain and discomfort increase. The rate of cesarean section in Iran is three times more than global standard. This study aimed to investigate effect of pre-warmed intravenous fluid therapy on prevention of shivering after general anesthesia in cesarean section.

Methods & Materials: A total of 62 women undergoing general anesthesia for elective cesarean section were randomly allocated into two intervention and control groups. In the intervention group, patients received pre-warmed serum (37°C) and in the control group, patients received serum at room temperature (25.5°C). The postoperative shivering and some homodynamic parameters of the participants were assessed in recovery room.

Results: The mean of body temperature in the intervention and control groups were 35.9°C±0.48 and 35.42°C±0.6, respectively (P<0.05). The incidence of post operative shivering in the intervention and control groups were 13% and 35%, respectively (P<0.05).

Conclusion: Infusion of pre-warmed serum (37°C) would prevent postoperative shivering and could improve nursing care for women underwent general anesthesia in cesarean section.

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  Background & Aim: Anxiety is associated with postpartum mood disorder and is increased with birth of high risk neonates. Foot reflexology is a nursing intervention that can be used to reduce anxiety. T he aim of this study was to evaluate the effect of foot reflexology on anxiety in mothers with high risk neonates after Cesarean section s .

  Methods & Materials: In this non-randomized clinical trial, 99 mothers having high risk neonates were recruited from the Women's General Hospital and Valieasr Hospital . The participants were allocated into three groups (n=33/group) using convenience sampling method . The group I received foot r eflexology for 40 minutes group II received leg massage and the control group received usual care after the Cesarean section. The Spielberger questionnaire was completed at baseline and three days after the interventions by the participants . Data were analyzed using the r epeated measure ANOVA and Chi-Squared in the SPSS-16 . 

  Results: At the baseline, there were no significant differences between the three groups in terms of demographic characteristics and the mean scores of anxiety . After the interventions, the mean score of anxiety was significantly lower in the reflexology and placebo groups than the control group (P<0.001). There was no significant difference between the reflexology and placebo groups in terms of the mean scores of anxiety (P>0.05). Comparing the mean score of anxiety between the reflexology (14.7±7.2) and placebo (9.4±8.5) groups indicated that the reflexology intervention was more effective in reducing anxiety .

  Conclusion: The use of foot reflexology was effective in reducing anxiety. Nurses should use this non-pharmacologic method to control the symptoms of anxiety among mothers .

  

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Background & Aim: Cesarean section (CS) rate was 56% in 2012 in Iran, which was considerably higher than the WHO recommended rate (10-15%). Thus, the Normal Delivery Promotion (NDP) program as a part of Iran’s Health Transformation Plan (HTP) was implemented in 2014 to reduce unnecessary cesarean deliveries and promote maternal and neonatal health. The aim of the study was to evaluate the effect of the NDP plan on the CS rates.
Methods & Materials: This quasi-experimental and longitudinal study analyzed the immediate and long- term effects of the NDP program on the CS trend in Iran using an interrupted time series analysis. Monthly CS rates in the hospitals of the country were extracted from April 2013 to September 2018.
Results: Overall CS rate in Iran decreased by 6% immediately after the implementation of the NDP program and then remained at the same level. The NDP program reduced the CS rate in teaching (9.5%), non-teaching (11.7%), private (18.1%), and charity (27.1%) hospitals. But the CS rate increased in social security (7%) and other hospitals (15.7%). The CS rate would have reached 58.5% by September 2018 if the NDP program had not been implemented.
Conclusion: The NDP program was somewhat effective in reducing the CS rate in Iran. Promoting this program by formulating a strategic plan and comprehensive action plans addressing various underlying causes of CS at meta (ministry of health), macro (universities of medical sciences), meso (hospitals) and micro (obstetricians, midwives, and mothers) levels and considering effective solutions in the areas of governance and leadership, financing, human resources, equipment, information and service delivery is critical to achieve the determined national goals.
 

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Background & Aim: Fear of childbirth is one of the reasons for choosing cesarean section. Given the consequences of repeated cesarean section, interventions that control the fear of childbirth are important in mother's decision for the mode of birth. The aim of the study is to assess the effect of individual counseling based on the Fogg model on the motivation and the fear of natural childbirth in women with previous cesarean section.
Methods & Materials: In this clinical trial, 62 pregnant women with a previous cesarean section, referred to Mashhad Comprehensive Health Centers in 2020, were randomly assigned into intervention or control groups. In the intervention group, individual counseling based on the Fogg model was provided in two face-to-face 45-60 minute sessions biweekly and one non-face-to-face session on the Telegram channel at 28-30 weeks of pregnancy. Data was collected by a demographic form, the motivation questionnaire, and the Wijma expectation/ experience questionnaire at the beginning and two weeks after the intervention. Data analysis was performed using statistical tests by the SPSS software version 25 at a significance level of 0.05.
Results: The mean difference of the fear of childbirth score before and after the intervention was 15.84±20.07 for the intervention group and 6.06±23.28 for the control group. Counseling with the fog approach has significantly changed the fear of childbirth score in the intervention group compared to the control group (P<0.001), but the changes in motivation were not statistically significant.
Conclusion: Counseling with the Fogg approach reduced the fear of childbirth score. It is recommended to use this counseling method to reduce the fear of childbirth, and to use strategies to increase the motivation for natural childbirth after cesarean section.
Clinical trial registry: IRCT20200105046014N1

 

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Background & Aim: Reducing pain after surgery, especially cesarean section is one of the most important factors for maternal and infant health. Choosing the way of reducing pain with fewer complications has drawn the attention of researchers. The aim of this study was to compare the effect of Hugo point pressure and auricular seed acupressure on pain after cesarean section.
Methods & Materials: In this clinical trial, 168 pregnant women who were candidates for cesarean section, referred to the educational and medical centers of Rafsanjan University of Medical Sciences in 2020, were selected through purposive sampling and randomly divided into three groups: Hugo point pressure, auriculotherapy, and control. In the Hugo group, massage was applied on the li4 point (between the thumb and forefinger) for 10 minutes. 24 hours later, the intervention was repeated. Before and after the intervention, pain intensity was measured using the Visual Analogue Scale (VAS). In the auriculotherapy group, earrings were placed on the Shenmen point located in the earlobe. Pain was assessed by the VAS 20 minutes after the intervention and 24 hours later. No intervention was performed for the control group and only the researcher was present next to the studied subjects for 10 minutes. Data were analyzed by the SPSS software version 20 using paired t-test and one-way analysis of variance (ANOVA). P<0.05 was considered significant.
Results: The average pain score in the Hugo group was 6.70±1.55 before the intervention and 6.20±1.78 after the intervention (P=0.026). In the auriculotherapy group, the average pain score before the intervention was 5.99±1.75 and after the intervention was 4.66±2.01 (P<0.001). No significant difference was observed in the average score of pain intensity on the first day between the two groups, before the intervention (P=0.062). But the average score of pain intensity on the first day after the intervention was lower in the auriculotherapy group compared to the other two groups (P<0.001). On the second day, there was a significant difference in the average pain score between the three groups after the intervention (P=0.009).
Conclusion: The results of this study showed that both auriculotherapy and the Hugo method are effective for reducing pain after cesarean section; but the continuance of pain reduction after auriculotherapy was more than Hugo point pressure. These methods can be used along with other pharmaceutical methods to reduce pain after cesarean section.
Clinical trial registry: IRCT20131228015965N17

 

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Background & Aim: The utilization of emotional expression methods, including narrative counseling and written emotional expression, has been shown to be efficacious in mitigating the intensity of diverse psychological issues such as depression and acute stress, particularly following traumatic events. Additionally, emergency cesarean section is commonly acknowledged as a traumatic event that may lead to psychological challenges for the mother. The purpose of this research was to compare the effectiveness of emotional expression through writing and narration in reducing post-traumatic stress and postpartum depression among women undergoing emergency cesarean section.
Methods & Materials: This quasi-experimental study was conducted in Zahedan, involving a total of 120 women who underwent emergency cesarean section and were admitted to Ali Ibn Abi Talib (AS) hospital during the period of 2021-2022. The participants were selected using convenience sampling and were randomly divided into three groups: written emotional expression, narration and control, with each group consisting of 40 participants. The intervention consisted of one face-to-face session and two non-face-to-face sessions. Data collection involved the use of the Edinburgh Depression Questionnaire and PTSD assessments, administered before and six weeks after the intervention across all three groups. The data were analyzed using SPSS version 24, employing descriptive and inferential tests such as ANOVA and Tukey's post hoc analysis.
Results: The results showed a significant decrease in the average scores of post-traumatic stress and postpartum depression in the written emotional expression and narration groups, compared to the control group, after the intervention (P<0.05). However, before the intervention, there were no significant differences observed among the three groups (P>0.05). Furthermore, a higher mean difference was observed in both post-traumatic stress and postpartum depression scores before and after the intervention in the written emotional expression group, compared to the narration group, indicating a greater effect of written emotional expression (P<0.001).
Conclusion: Based on the research findings, highlighting the positive effect of both narration and written emotional expression, it is recommended to incorporate these techniques as supplementary components within comprehensive educational and care programs for women experiencing traumatic childbirth.