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Childbirth is one of the most stressful situations in a woman's life. In order for a woman to adjust to the stress of delivery and to make it a happy experience for her, she should be supported with adequate information as well as emotionally and physically. This research was undertaken to analyze the opinion of mothers concerning the importance of and their satisfaction with information, physical and emotional support received in the labor and delivery rooms. In this descriptive-analytic study 400 post-partum mothers from 10 various training hospitals in city of Tehran in the year 2000 were randomly selected and interviewed by questionnaire in the post-delivery ward. Results showed that most of the mothers placed great importance on physical, informational, and emotional support, respectively. They had received inadequate physical and informational support and relatively adequate emotional support. But most of them were satisfied with the informational, emotional and physical support, respectively. There was no significant association between the level of satisfaction of the mothers with these three types of support and their importance but there was a significant association with the way that support was received. (P<0.05). Complete satisfaction with the support offered, despite their inadequacy or limitations, may be due to the fact that mothers are unaware of their rights and have few expectations or may be due to the time of conducting the interview (just before discharge). The lack of any relation between the demographic variables and the value of importance in the different areas of support shows that these are basic needs and all should be equally provided. In order to increase satisfaction, support and care should be provided to mothers in the best possible fashion. Finally, regarding the presence of midwifery students and their teachers in teaching hospitals, they should be made directly responsible for the reformation of the hospital system, preparation of hospital charts and their organization.

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Introduction: The delivery of placenta and membranes (third stage of labor) is an important stage of delivery. Complications of this stage can increase maternal mortality rate. There is controversy regarding the routine use of oxytocic drugs in this stage of labor. These drugs may shorten duration of third stage but have side effects. Furthermore, management of delivery in physiologic way causes minimum damage to the mother and newborn.

Materials and Methods: The present research is a clinical trial study. A total of 94 subjects were divided into two groups. All subjects in active group received 10 units of Syntocinon in 500 cc serum. The cord was clamped and cut after cessation of pulsation and the placenta was delivered by Brandt–Andrews maneuver. Women in the physiologic group received 1cc of placebo in 500 cc serum, no clamping of the cord was attempted until pulsation had ceased and the placenta was delivered by minimal traction on the cord and with maternal effort without any maneuver.

Results: Two groups were matched in the subjects’ characteristics. The rate of postpartum hemorrhage in physiologic group (14.58%) was higher than active group (10.64%) but the statistical tests showed no significant differences between two groups (p=0.2945). The mean duration of the third stage of labor in the physiologic group (13 minutes) was longer than active group (9 minutes) but the statistical test showed no significant differences between two groups. The statistical tests also showed no significant differences between rate of retained placenta (p=0.5) or piece of the placenta and membranes (0.2428) in two groups.

Conclusion: Statistical tests showed no significant differences between duration and complications of the third stage of labor in two groups. The routine use of Syntocinon in management of third stage of labor can not be recommended.

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Pregnancy and delivery are special events in women’s and their family’s life. Although pregnancy is a natural phenomenon and not a disease, sometimes it can be associated with several dangers to the mother and her fetus. Maternal death is a global finding and its five most important causes are bleeding, infection, hypertension, prolonged labor and abortion in unsanitary condition. Early diagnosis of abnormal labor progression and prevention of prolonged labor can reduce the risk of postpartum bleeding and infection. The chart of labor called “Partograph” has been introduced and applied since 1970 to help diagnosis of the abnormal labor and cephalopelvic disproportion. Partograph is an early alerting system which can prevent probable difficulties in different stages of labor through recording of all of the observations and examinations on one chart, so that mother can be referred as soon as possible to higher levels of health services.

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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.

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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.

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Background & Aim: Socio-economical changes have increased the women&aposs opportunity to take job in recent decades. The increased levels of women in work places, has resulted in a high interest in the potential adverse effects of work on pregnancy outcome. This study was conducted in order to surveying the association between occupational factors and preterm childbirth.

Methods & Materials: It is a cross-sectional study. Samples consisted of nurses and midwives (518 person) who working in Tehran&aposs universities of medical sciences hospitals. Also they delivered newborns in gestational age more than twenty weeks (term or preterm) in years 2001-2006. The subjects were selected using a multi stage sampling method. Data gathered using a self-administered questionnaire. Occupational factors labeled as fatigue score and working hours. The relation between Occupational factors and preterm birth was analyzed using descriptive and inferential statistics (Chi-squared, t-test and Mann-Whitney U test) by SPSS software.

Results: Based on the study findings, the prevalence of preterm labor was 17.2% (95%CI=0.14-0.20). Although the proportions of unfavorable working conditions include: working at acute clinical wards, standing up more than 3h per each working shift, physical exercise, working in cold or hot weather, working in busy environment with continuous noise, being checker of visual and aural monitoring signals, working hours equal or more than 40 hours per week, and working fatigue score equal or more than 3 were higher in preterm group but it didn&apost show any significant relation with preterm birth.

Conclusion: According to the research findings, it seems that occupational factors do not have explicit effect on preterm childbirth. Therefore more investigations are recommended.

 

Key words: Preterm Labor, Occupational Factors, Fatigue

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Background & Aim: Labor pain is regarded as one of the most intolerable pains which women experience during their life. Although there are many alternatives which can effect on person&aposs response and perception to pain and suffering, the pain is felt especially more severely and longer by primogeniture. Annually thousands of selective cesarean operations are performed just because of delivery pain frightening as the main reason. The pain can produce diverse and unwanted effects on delivery procedure and mother-fetus condition. So finding a method to relieve the pain and suffering is one the policies intently considered by health care systems. The aim of present study is to determine the effect of Entonox on implication of painless labor and woman&aposs satisfaction in a Hospital in Orumieh in 1385.

Methods & Materials: This research is a single blind clinical trail. Samples were consisted of women (160 persons), in two groups (each group 80 persons), which selected randomly. The intervention group used Entonox and the control group inhaled Oxygen. All subjects were instructed to use Visual Analogue Scale (VAS) and to inhale gases correctly. Due to emergency need for caesarean operation 2 members of the intervention group and 3 ones from the control group leaved the study. Data gathering tool were consisted of data registration form, VAS scale, mother vital sign recorder, and fetus heart rate recorder. The data were analysed using descriptive (relative & absolute frequencies, mean, and standard deviation) and inferential statistics (t-test, Mann-Whitney U, Chi-squared, Kolmogrove-Smirnov test) by SPSS computer software.

Results: According to the findings pain severity rate among the intervention group significantly was lower than the control group in the different hours of delivery procedure (P<0.001). Using Entonox made no effect on mother&aposs vital signs, labor process, fetus heart rate, first and fifth minute Apgar and bleeding rate after delivery. Also it was shown that probable side effects of Entonox inhalation such as drowsiness and mouth stiffness were more common in the intervention group (P<0.001), but no significant difference was seen in other complications. Meanwhile delivery satisfaction rate was higher in the intervention members.

Conclusion: It seems that Entonox inhalation might come in useful as an effective and safe method to alleviate labor pain and suffering along side with fewer likely risks for fetus and mother in clinical centers.

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Background & Aim: Labor refers to a chain of physiologic events that allows a fetus to undertake its journey from the uterus to the outside. Friedman (1954) described a sigmoid pattern for labor. This study was carried out to compare the pattern of labor progression in nullipara women of Fasa with the Friedman&aposs labor curve.

Methods & Materials: This cross-sectional study was conducted among 619 nulliparous women aged 18-35 who had term delivery and had no serious disease. In order to data analysis, we used one way ANOVA for comparing the means, and fixed effect of regression models in reverse method for curves drawings.

Results: In all of the subgroups, effacement rate increased by increasing the cervical dilatation. Mean of dilatation rate was significantly higher in induced group than the other groups. Duration of the active phase was longer in the group that had sedation than the other two groups. Means of the duration of active phase and second stage were significantly lower in our study than the durations in the Freidman&aposs study (P<0.001) (3.87 hours vs. 4.9 hours and 52 minutes vs. 57 minutes, respectively). We did not observe the deceleration phase in our study.

Conclusion: The pattern of labor progression differed from the Freidman&aposs curve and had not sigmoid shape. The most important factor in latent phase was the time of admission to the labor ward.

 

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Background & Objective: Labor pain is usually the most severe pain women experience in their lives. Most women suffer from low back pain during first stage of labor. The pain can produce adverse effects on delivery procedure. Because of potential side effects of medications used in labor, alternative methods for pain relief have received more attention nowadays. The aim of this study was to evaluate the effect of subcutaneous injection of sterile water on labor pain, type of labor, and satisfaction with pain management in nulliparous women.
Methods & Materials: This was a randomized single-blind study. Samples were consisted of 80 women who were randomly allocated to two intervention and control groups. In the intervention group (40 women) sterile water was injected subcutaneously in four sacral regions during first stage of labor. In the control group, we just inserted a needle in the same area. Low back pain intensity was assessed before and 10, 45, and 90 minutes after the injections using visual scales in both groups. Data were analyzed using descriptive (relative & absolute frequencies, mean and standard deviation) and inferential statistics (t-test, paired t-test and c²) in the SPSS.
Results: There was no significant difference between two groups at baseline. The mean of pain intensity in 10 and 45 minutes after the injection was decreased significantly in the intervention group (P=0.00). There was no significant difference between two groups in the 90^th minute. There was no difference in the type of labor between two groups. The mean of the satisfaction score was higher in the intervention group than in the control one.
Conclusion: It seems that subcutaneous sacral injection of sterile water might be an effective and safe method to alleviate labor pain in women

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Background & Objective: Preterm labor is a major risk factor of mortality and morbidity in newborns and fetuses. Low birth weight is also a risk factor for mortality and various neonatal diseases. This study aimed to determine the association between the CRP levels in first trimester of pregnancy with low birth weight and preterm labor.

Methods & Materials: In this prospective cohort study, we measured serum CRP levels in 400 pregnant women up to 20 weeks of gestation. All participants were followed up to delivery. Preterm labor was defined as delivery before 37 weeks of gestation. Low birth weight was defined as weight less than 2500 g at birth. Statistical analysis was done using Chi-square, Logistic regression, and ROC curve. P-values less than 0.05 were considered to be significant.

Results: After controlling for the effects of age above 35 years, mothers&apos occupations, history of preterm labor, socio-economic status, history of abortion, primiparity, and passive smoking, logistic regression analysis showed statistically significant relationship between the CRP and preterm labor (P-value=0.000, OR=1.24, %95 CI=1.11-1.38). However, there were no significant relationships between the CRP levels with other factors. Using Roc curve, we determined CRP cut-off point level for preterm labor. With 81% sensitivity, and 64% specificity, CRP cut-off point was 3.45 mg/l. After controlling for the effects of low socio-economic status, history of LBW, history of abortion, gravidity, primiparity, and passive smoking, logistic regression analysis showed statistically significant association between the CRP levels and LBW (OR=1.31, CI %95=1.08-1.59, P=0.005). However, there were no significant relationships between CRP levels with other factors. CRP cut-off point level for LBW was determined using Roc curve. With 87.5% sensitivity, and 74% specificity, CRP cut-off point was 4.75 mg/l.

Conclusion: It seems that the inflammatory marker, CRP, can be used to identify women who are at high risk for preterm labor and LBW. However, larger studies are needed to establish this relationship definitively

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Background & Objective: Labor pain management is one of the most important procedures of midwifery cares. Acupressure, a non-pharmacological method of labor pain relief, is an available, easy to use, inexpensive, and without side effect method of pain relief. The purpose of this study was to compare the effects of LI-4 acupressure on labor pain in women during first stage of labor.

Methods & Materials: A single blind randomized clinical trial study was carried out on 83 primipara women. The inclusion criteria were singleton pregnancy in 38-42 weeks of gestation, cephalic presentation, and spontaneous uterine contractions. Participants were divided into three groups including acupressure group, touch group, and the usual care (control group). The intensity of labor pain was measured using visual analog scale with the rating from 0-100 mm immediately, 30 minutes, and one hour after the intervention during the first stage of labor. Data were analyzed using statistical tests of ANOVA, Chi-square, and Exact chi-square.

Results: Findings indicated that acupressure group had lower labor pain in the active phase of the first stage of labor immediately after intervention than the other groups (P=0.026).

Conclusion: The results of this study suggested that LI4 acupressure reduced the intensity of labor pain in the first stage of labor without any side effects to mother and infant. This procedure can be used as a simple, safe and inexpensive method to relief labor pain.

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Background & Aim: This study aimed to assess the relationships between iron and copper levels in maternal and cord serums together and with pregnancy outcomes.

Methods & Materials: An Analytical cross-sectional study was conducted among 370 pregnant women in labor and their neonates in Maryam, Akbarabadi and Imam hospitals in Tehran, Iran. Copper concentrations were measured using the standard atomic absorption spectrophotometer method and Iron concentrations were measured by a kit through RA 1000 method. Data were collected using a questionnaire and were analyzed using Spearman correlation, Chi- square and Logistic regression tests.

Results: The mean copper concentrations in the maternal and cord bloods at delivery were 114.52±37.4, 22.4±11.6 (μg/dl), respectively. The Iron levels were 119.2±64, 164.3±65.3 (μg/dl), respectively. Of all the mothers, 54.3% had copper deficiency, 1.1% Iron deficiency and of all the newborns, 44.7% had copper deficiency and 3.5% Iron deficiency. The Spearman Correlation analysis showed significant positive correlations between concentrations of each element in maternal serum with cord serum and also between maternal iron with maternal copper, and maternal iron with cord copper. The Chi-square analysis showed that there was a significant relationship between maternal copper deficiency and gestational hypertension (P<0.001). There were no significant relationships between these trace element levels at delivery with premature rupture of membranes and preterm labor. Logistic regression analysis showed a significant negative relationship between maternal copper levels and gestational hypertension (odds: 0.98, 95%CI: 0.97-0.99).

Conclusion: Maternal copper deficiency was rather high in the participants of the study (54.3%), and was related to incidence of gestational hypertension. These findings illustrated importance of trace elements during pregnancy. Providing suitable dietary recommendations and giving supplements during pregnancy can help to decrease maternal and fetal mortality and morbidity.

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  Background & Aim: Limitation of fluid intake in parturient can affect uterine contractions. Several studies have been conducted on the effect of hydration in labor progress and reported different results. In the present study, we evaluated the effect of over IV hydration on duration of labor and outcome of pregnancy in parturient women .

  Methods & Materials: In this randomized clinical trial, 120 nulliparous women admitted to Ilam Mustafa Hospital were selected from February 2010 to December 2010. All participants had non-complicated singleton pregnancies and were randomly assigned in four groups. The first group received usual care while the second to fourth groups received lactated ringers at 60, 120 and 240 ml per hour (IV fluid groups), respectively throughout active labor phase. All women had unrestrictedly access to oral fluids. The analysis was done using the ANOVA and Chi-squared tests in the SPSS-16. The p-value less than 0.05 were considered to be statistically significant . 

  Results: Key variables known to affect labor outcomes were statistically similar in all groups. The mean duration of active phase of labor was lower in the intervention groups in comparison with the control group. All groups had significant differences in the duration of second stage of labor, Oxytocin augmentation, and prolonged labor. There was a trend toward a lower frequency of the Cesarean deliveries in the 240 ml group however it was not significant. There was no significant difference in the Apgar scores between groups .

  Conclusion: Over IV hydration reduced duration of labor. There were no reports of poor outcomes for mother and infants .

  

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Background & Aim: Mother’s intense fear of and anxiety about labor pain lead to muscle contractions. Intense muscle contractions especially uterine contractions interfere with the normal process of labor. So, this study aimed to investigate the effect of salvia aroma on reducing the women’s anxiety level during labor.

Methods & Materials: The present study was a two-group randomized clinical trial (IRCT2016042727633N1) conducted in 2015 on 160 pregnant women laboring in Motazedi Hospital in Kermanshah. The subjects were randomly assigned into two groups. Prior to the intervention, the Spielberger’s State-Trait Anxiety Inventory (STAI) was completed by both groups and the anxiety scores were determined. In the intervention group, immediately after the onset of the active phase of labor, a gauze impregnated with three drops of the salvia essence was attached to the samples’ collars and repeated every half an hour. In the control group, a placebo was administered in a similar way. After the intervention, anxiety was measured at a cervical dilation of 5-7 cm. The chi-square test, Fisher test, Kolmogorov-Smirnov test, Wilcoxon and Mann-Whitney tests were employed to analyze the data.

Results: The mean score for anxiety was similar in the two groups prior to the intervention (P=0.15). However, after the intervention the mean score for anxiety was lower in the aromatherapy group (39.86±10.39) than in the control group (64.25±7.41) (P<0.001).

Conclusion: The findings suggested that the level of labor anxiety was reduced using aromatherapy with salvia essence. Accordingly, the use of salvia essence aroma is recommended for reducing anxiety labor.