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This was an analytical study that was conducted to determine effective factors on childbirth with an interval of less or more than two years in health clinics of Zahedan in 1997-1998.The samples consisted of 400 women with a childbirth interval of less than two years and 800 women with a childbirth interval of more than two years. The women with the following criteria were surveyed: gestational age at the time of delivery (27 months or more ), no abortion during the interval of two last childbirth and living with their husbands during the investigation period. Moreover, women's demographic data (such as age, education), the quality of their last pregnancies, the role of men in contraception and the contraceptive methods were also analyzed.The results indicated that there was a significant relationship between the follwing variables and establishing an interval of childbirth: maternal delivery age, education, number of male children and the number of the last pregnancy with an interval of childbirth (pRegarding the unwanted pregnancies, the findings revealed that lactation 15.83% and lactation pills 53% were caused childbirth with an interval of less than two years, while, IUD 76.47% caused childbirth with an interval of more than two years and contraceptive injections 46.43% caused an interval of 2-3 years.There was a significant statistically relationship between contraceptive method and childbirth interval (p <0.001 ).The participation of couples in establishing childbirth interval and applying IUD were confident methods in performing a childbirth interval of more than three years.It is recommended that women should be trained enough for the role of lactation as a contraceptive method. They also required training to apply other contraceptive methods coincidental.

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Background & Aim: Adverse childbirth experiences as a trauma can evoke fear and post-traumatic stress disorder in some women. This study was conducted to investigate the effect of counseling on post traumatic stress disorder after a traumatic childbirth.

Methods & Materials: This research was a clinical trial which was conducted at Kamaly hospital in Karaj. Samples (300 women) who had experienced a traumatic childbirth were selected by a convenient sampling method and were randomized into an intervention (n=150) and a control (n=150) group. The intervention group received face-to-face counseling within 72 hours of birth for forty to sixty minutes in a session. The control group just received usual care after childbirth. The data collection tool was questionnaire, which was completed via interview. The measuring variables were demographic characteristic, reproductive history, maternity social support, and post-traumatic stress disorder. Data were analyzed using descriptive statistics and inferential tests (Chi-square, Fisher&aposs exact test, and generalized Fisher&aposs exact test) by SPSS v.13 software.

Results: After 4-6 weeks of follow-up there was no significant difference regarding post-traumatic stress disorder between two groups (P=0.295). At 3-month of follow-up, the intervention group reported less post-traumatic stress disorder comparing with the control group (P=0.001).

Conclusion: A midwife-led counseling plan is effective in reducing post-traumatic stress disorder during a long term.

 

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  Background & Aim: Women who experience anxiety during labor are more vulnerable to physical and mental illnesses. Emotional support by a knowledgeable individual can improve physical and even mental conditions. This study aimed to determine the effect of presence of a Doula in delivery unit on parturient women’s anxiety .

  Methods & Materials: This is an experimental study using a randomized interrupted time series with a control group. Using convenience sampling, 64 parturient women with research inclusion criteria were randomly assigned to the control or intervention groups. The parturient women in the intervention group benefited from presence of a Doula and her support. The control group received the usual care without presence of the Doula. Data were collected using the Spielberger state-trait anxiety inventory and a checklist. The results were analyzed using parametric and non-parametric statistical tests in the Stata-11 . 

  Results: The age, education, family income, location of residency, the trait and state anxiety did not have any differences between the two groups at the baseline. After the intervention, the state anxiety was reduced significantly in the intervention group compared with the control group at the time of leaving the labor room, delivery room and recovery room (P<0.001) .

  Conclusion: According to the present research findings, Doula can significantly reduce the anxiety level and its complications among parturient women during childbearing .

  

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Background & Aim: Maternal request for caesarean section due to fear of normal vaginal delivery (NVD) is one of the main reasons for the high rate of caesarean section. This study aimed to compare the fear of NVD and type of delivery between two groups of pregnant women attended childbirth preparation classes (CPC) and women received routine prenatal care (RPC).

Methods & Materials: In this prospective cohort study, 202 Primigravid women attended healthcare centers for prenatal care services in the East of Guilan were selected using convenient sampling in 2013-2014. Fear of NVD was assessed using a childbirth attitude questionnaire at two stages (before attending CPC or receiving RPC, then at the third trimester of pregnancy). Both groups were followed up to the delivery time. Data were analyzed using inferential and descriptive statistics (Chi square, paired t-test, ANOVA, t-test) through SPSS v.16. P<0.05 was considered as significant.

Results: There was no significant difference (P=0.23) in the mean score of fear of NVD between two groups before attending CPC (35.59±8.78) and receiving RPC (37.08±9.08). The comparison of the mean score of fear of NVD between two groups at the third trimester of pregnancy showed a significant reduction (P<0.001) in the first group (32.30±8.31) than in the second group (37.29±9.55). A significant difference was also observed between two groups in the rate of NVD (P=0.002).

Conclusion: Results confirm the importance of CPC in decreasing fear of NVD and increasing the rate of NVD in primigravid women attended these classes. Therefore, women’s attendance at CPC is recommended to be encouraged.

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Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures.

Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures by mothers.

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Background & Aim: The physiologic childbirth program in Iran is an emerging program that needs to be evaluated like any other program to improve its quality and process. Evidence suggests that the implementation of the physiologic childbirth program faces some challenges. The present research aimed to explore the challenges of the physiologic childbirth program from the perspective of service providers.
Methods & Materials: This qualitative research was carried out through a content analysis method in two mother-friendly hospitals of Ahwaz and Mashhad in 2016-2017. Data were collected through semi-structured interviews with 17 physiologic childbirth service providers. The content analysis method of Elo and Kyngas was used for qualitative data analysis.
Results: Data analysis led to five main categories: low motivation of midwives in performing physiologic childbirth; barriers related to manpower; medical interventions in physiologic childbirth; challenges from the environment and facilities; and educational barriers.
Conclusion: Different challenges in interaction with each other create a complex environment in which the implementation of physiologic childbirth program becomes more difficult. Therefore, policymakers, authorities, doctors, midwives and mothers need to work in a coordinated way to resolve the mentioned challenge.
 

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Background & Aim: Tokophobia was introduced as a psychiatric disorder for the first time in 2000. The purpose of this study is to answer four questions: What is tokophobia and how does it occur? What is the global prevalence of tokophobia? What are the symptoms of tokophobia? and what are the strategies for the control and treatment of tokophobia?
Methods & Materials: This systematic review was conducted by searching articles in English and Persian published between January 2000 and January 2018 on international databases; PubMed, Scopus, Web of Science, Google Scholar, Science Direct, and domestic databases; Magiran and SID, along with a manual search in resources.
Results: After reviewing 151 articles, finally 16 were included in the study. The results indicate that tokophobia is a severe and pathological fear of childbirth. In the categorization of psychiatric disorders, it is classified as a specific phobia based on the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV). The etiology of tokophobia is multifactorial, and its prevalence in pregnant women was reported around 14 percent among 18 countries. The signs and symptoms of the disorder are insomnia, crying, restlessness, depression, anxiety and severe worry about childbirth. Psychological strategies, cognitive behavior therapy and medication have been proposed to reduce the fear of childbirth in women in different studies.
Conclusion: As a guide, these results can assist the healthcare team members to recognize and screen at-risk women as well as to perform nursing interventions and psychotherapy in the prenatal and delivery stages.
 

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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