Association Between Striae and Pelvic Organ Prolapse in Women: A Systematic Review and Meta-Analysis.

INTRODUCTION AND HYPOTHESIS: The high prevalence of pelvic organ prolapse (POP) and related complications shows the necessity of early identification of risk factors. It is considered that striae and POP share a similar physiopathology. However, the link between the two is still inconclusive and requires further investigation. We conducted this study to evaluate the association between striae and POP. METHODS: Databases such as PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched to find relevant literature from inception up to May 2023. Full-text articles published in English or other languages and observational studies were included. The statistical analysis was performed using STATA 14.2. The random effects model was performed and heterogeneity was ≥ 50%. Statistical tools such as the Chi-squared test and the I2 index were used to calculate the level of heterogeneity among studies. Additionally, we utilized Funnel plots and Egger tests to assess the presence of publication bias. RESULTS: Seven studies were selected for meta-analysis, yielding a total of 605 patients and 660 control subjects, to assess the link between striae and POP. The overall pooled odds ratio (OR) was 2.08 (95% confidence interval 1.04-4.19, I2 = 80.40%). Our analysis revealed a strong relationship between POP and striae (p < 0.001). CONCLUSIONS: This study recommends that stretch marks may be used as a helpful indicator of the risk for POP. Evaluation of striae as a risk factor and screening tool for detecting women at risk for the development of POP should be addressed in future well-designed studies. However, there is a need for high-quality studies in this field owing to the low quality of evidence.

Explaining the Educational Needs of Iranian First-Time Parents for Adaptation to Parental Role: A Qualitative Study.

Background: The transition to parenthood is one of the most challenging experiences in a couple's life, which can be stressful and difficult. A positive transition period affects the quality of parents' behavior and the baby's health. This qualitative study aimed to explain the educational needs of adaptation to parental role among first-time parents in Iran. Materials and Methods: In this qualitative study, 25 participants from a variety of ethnic backgrounds were recruited in Ahvaz, Iran, using purposive sampling. In-depth interviews were used to collect the data which were analyzed by qualitative content analysis. Results: Three main categories emerged from the data analysis: "The need for knowledge improvement training," "The need for psychological adaptation training," and "The need for sociocultural adaptation training." Conclusions: To adapt to the parental role, first-time parents should be equipped with the knowledge to turn the challenges of this period into an opportunity for growth. Moreover, they need to be supported by their family members, the healthcare team, and the government.

Factors Influencing Weight Management in Pregnant Women with Overweight or Obesity: A Meta-Synthesis of Qualitative Studies.

BACKGROUND: Overweight and obesity have multiple negative consequences for the health of both the mother and the child. Interventions to prevent excessive weight gain during pregnancy have had varying success, and the proportion of pregnant women who exceed national guidelines for weight gain continues to increase. OBJECTIVE: To investigate the influence of factors on weight management among pregnant women with overweight or obesity. METHODS: This meta-synthesis of qualitative studies involved searching databases PubMed, Embase, Cochrane, Scopus, and Web of Science. The databases were searched on October 4, 2022, and the search was updated on April 21, 2023. The screening of titles, abstracts, and full texts was conducted utilizing Covidence software. The quality assessment of the articles was performed using the Critical Appraisal Skills Programme checklist. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was used to enhance transparency in reporting. A meta-aggregation approach was used to guide the data extraction and synthesis. RESULTS: A total of 46 studies with appropriate Critical Appraisal Skills Programme scores were included for qualitative synthesis. Findings were extracted and integrated into 4 themes: psychological factors (personally driven negative emotions and society-driven negative emotions), social factors (societal attitudes and beliefs and social support resources), factors related to education and counseling (information provision and communication), and factors associated with effective care (provided care components and the method of providing effective care). CONCLUSIONS: To improve weight management during pregnancy, health care providers should provide tailored and individualized recommendations that take into consideration the factors influencing these women.

Effect of the Parenting Preparation Program on Maternal Role Competence: A Systematic Review and Meta-Analysis.

Background: The maternal sense of competence refers to the mother's sense of ability to care for the baby. Maternal competence can affect the mother's parenting capacities. Maternal preparation programs are aimed to increase mothers' knowledge and improve their maternal competence. This systematic review and meta-analysis investigated the effect of a maternal preparation program on maternal role competence. Materials and Methods: A systematic search was conducted using the following MeSH terms: "education", "program", and "parenting sense of competence" in databases including PubMed, Web of Science, Cochrane Central, and Scopus, from inception till July 2022. All Randomized Controlled Trials (RCTs) published in any language were extracted. Articles were screened based on predefined inclusion and exclusion criteria. The quality of the included articles was assessed by two qualified reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Of the 170 published works that were retrieved in the initial stage, five articles including 647 first-time mothers were analyzed. A meta-analysis showed that parenting preparation program interventions increased maternal role competence in first-time mothers as opposed to those who received routine care Mean Difference (MD) = 3.31, 95% Confidence Interval (CI) [2.07, 4.55]. Conclusions: The results of this study encourage health policymakers to develop maternal preparation programs for first-time mothers and their children.

Primiparous Mothers' Perception and Expectations Regarding Social Support during the Postpartum Period: A Qualitative Study.

Background: Social support has been found to positively influence the mothering experience. Yet little is known concerning primiparous mothers' perceptions of social support following childbirth. This qualitative study aims to explore primiparous mothers' perception and expectations regarding social support during the postpartum period. Materials and Methods: This qualitative study with content analysis approach was conducted on 11 postpartum mothers who had been routinely referring to comprehensive health service centers in Kermanshah, Iran, from October 2020 to January 2021 for receiving postpartum care within the first 6 months after birth. Also, to further enrich the study data, interviews were conducted with healthcare providers (n = 6) and husbands (n = 3). Twenty-two semi-structured interviews were conducted individually through a purposive sampling method. Two participants were interviewed twice. Interviews were recorded and transcribed verbatim in Persian and analyzed using conventional content analysis. Results: Three main categories and thirteen subcategories emerged. The main categories were: "comprehensive support", "support barriers," and "support promotion strategies." The main perception and expectation of mothers regarding social support was the sense of not being alone and receiving comprehensive support, especially from the husband and increasing his awareness about this support. Conclusions: An understanding of a comprehensive support, support barriers, and support promotion strategies with respect to social support can help healthcare professionals to develop interventions and programs aimed at promoting mothers' social support in the postpartum period.

Evaluation of the effectiveness of a postnatal support education program for husbands in promotion of their primiparous wives' perceived social support: a randomized controlled trial.

BACKGROUND: Primiparous women experience various challenges if not provided with social support in the early postpartum period. Support in form of postpartum education programs is needed to improve mental well-being in primiparous women. The aim of this study was to determine the effect of a postnatal supportive education program for husbands on the perceived social support (primary outcome), and stress and maternal self-efficacy (secondary outcome) of their primiparous wives. METHODS: This randomized clinical trial was performed on pregnant women referring to healthcare centers for routine care from September to November 2021 in Kermanshah, Iran. One hundred pregnant women were randomly divided in to intervention and control groups. Four 45-90 min online training sessions were held weekly for the husbands of the intervention group. The primiparous women completed the Postpartum Partner Support Scale, Perceived Stress Scale, and Postpartum Parental Expectations Survey before (third day after delivery, immediately and one month after completing the intervention. Data were analyzed using Fisher's exact test, Chi-square test, independent t-test, and repeated measures analysis of variance in SPSS version 24, and p < 0.05 was considered statistically significant. RESULTS: In the control and intervention groups before the intervention, socio-demographic characteristics (P > 0.05), the mean scores of perceived social support (P = 0.11), maternal self-efficacy (p = 0.37) and perceived stress (p = 0.19) were not statistically significant. However, in the intervention group compared to the control group the mean scores of perceived social support (79.42 ± 7.17 vs. 37.26 ± 7.99, P < 0.001), maternal self-efficacy (186.22 ± 39.53 vs. 106.3 ± 32.88, P < 0.001) and perceived stress (16.36 ± 6.65 vs. 43.3 ± 7.39, P < 0.001) immediately after the intervention and the mean scores of perceived social support (84.4 ± 5.91 vs. 37.14 ± 6.63, P < 0.001), maternal self-efficacy (191.24 ± 38.92 vs. 112.34 ± 37.12, P < 0.001) and perceived stress (13.98 ± 4.84 vs. 39.06 ± 7.25, P < 0.001) one month after the intervention changed significantly. CONCLUSION: The postpartum supportive education program for husbands was effective in promoting social support for primiparous women. Thus it can be introduced as routine care in the postpartum period. TRIAL REGISTRATION: Clinical trial registration Iranian Registry of Clinical Trials; https://en.irct.ir/user/trial/56451/view (IRCT20160427027633N8), registered (15/06/2021).

Effects of Aromatherapy With Citrus Aurantium Lavender on Sexual Function of Postmenopausal Women: A Randomized Controlled Trial.

Objective: The purpose of this study was to explore the effectiveness of aromatherapy with Citrus aurantium Lavender on the sexual function of postmenopausal women. Materials and methods : A randomized controlled trial with single-blind design was conducted on eighty postmenopausal women in Ahvaz, Iran from January to December 2019. The women were randomly assigned to the Citrus aurantium group (n=40) and placebo group (n=40). The intervention group received two drops of Citrus aurantium essential oil twice a day, for four consecutive days a week, for four weeks as inhalation. Similarly, placebo was received by the control group. Results: The results of this study revealed that in the intervention group, the FSFI total score and all of its dimensions were significantly improved compared to the control group. Conclusion: Aromatherapy using Citrus aurantium can be used as an alternative or complementary method for improvement of sexual function in postmenopausal women. It is recommended that the postmenopausal women suffering from sexual dysfunction be informed on the aromatherapy by Citrus aurantium essential oil.

Interventions to improve social support among postpartum mothers: A systematic review.

Background: Poor and insufficient social support to the mother in the post-partum period impairs the effective functioning of her new role as a mother, and it is an important risk factor for the maternal depression and stress after childbirth. Thus, interventions to improve social support to mothers in their postpartum period are required. The present review aimed to investigate the effectiveness of the existing interventions aimed at improving social support among postpartum women. Methods: In this systematic review, PubMed, Scopus, Science Direct, Cochrane Library, Web of Science, EMBASE, Google Scholar, IranDoc, IranMedex, MagIran and SID were searched until January 2022. Full-text articles on the social support outcome, published in English or Persian, which used the design of randomized controlled trials (RCTs) or comparison groups and involved postpartum or pregnant women as participants were included. The quality of the studies was assessed based on the seven criteria offered by Cochrane guidelines. Results: Our review included 10 studies involving 3328 women. According to our results, the following interventions were successful in increasing social support compared to the controlled conditions: counseling with men in the prenatal period, interventions based on interpersonal psychotherapy (IPT), advanced practice nurse (APN), internet support, and home visiting in the postpartum period. Conclusion: These interventions could be provided to mothers during their prenatal or postpartum care. However, which one of these interventions is the most effective in improving social support among postpartum mothers was not identified in the present study.

The effectiveness of cognitive-behavioural consultation on sexual function and sexual self-efficacy of women after childbirth.

Objective: The purpose of this study was to investigate the effect of the cognitive-behavioral therapy program (CBT) on the sexual function and sexual self-efficacy of 100 women after childbearing. Methods: In this experimental pretest-posttest and control group design study, women who passed eight weeks of their delivery and were referred to three health centers, in Shadegan, Iran, from January to April 2019 registered using the simple sampling method and randomly allocated into two groups of case and control. For the CBT group eight weeks of counseling (one session/week), and for the control group, routine educations were provided by health care providers. Both groups filled out the female sexual function index and sexual self-efficacy questionnaires before intervention and eight weeks after the last session. Results: There was no significant difference between the CBT and control groups before the intervention in terms of sexual function and sexual self-efficacy, but eight weeks after the intervention, there was a statistically significant difference between the two groups (P = 0.001). Conclusion: Proper implementation of counseling based on the CBT model improved sexual function and self-efficacy of nulliparous women after childbirth.

The Effect of Citrus Aurantium Aroma on the Sleep Quality in Postmenopausal Women: A Randomized Controlled Trial.

Background: One of the most common problems in menopausal women is sleep disturbance. Citrus aurantium has sedative, hypnotic, and anti-anxiety effects. The aim of this study was to investigate the effect of Citrus aurantium aroma on the sleep quality of postmenopausal women. Methods: This was a double-blind randomized controlled trial that was conducted from Feb to Dec 2019 on 80 postmenopausal women who suffered from sleep disturbances. The participants were assigned into two groups randomly. Women in the intervention group were requested to use 2 drops of essential oil of Citrus aurantium, twice a day, for 4 consecutive days in a week, for 4 weeks as inhalation. The control group received almond oil in the same way. The quality of sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI) before the intervention and 4 weeks after the intervention started. The data were analyzed using the SPSS statistical software, version 21, and P<0.05 was considered statistically significant. Results: After 4-weeks of intervention, the mean score of sleep quality was significantly lower in the Citrus aurantium group compared to the control group (5.75±1.33 vs 13±1.59, P<0.001). In the intervention group, all dimensions of PSQI were improved significantly (P<0.001). Conclusion: The results of this study showed that the aroma of Citrus aurantium essence could significantly improve the sleep quality of postmenopausal women. Therefore, it is recommended that health care providers should inform the postmenopausal women and advise them to use this intervention for reduction of sleep disorders. Trial Registration Number: IRCT20160427027633N7.

Women's perception of continuity of team midwifery care in Iran: a qualitative content analysis.

BACKGROUND: Understanding the pregnant women's perception of continuity of team midwifery care is necessary for introducing and implementing this model of midwife-led care in the Iranian maternity services. This qualitative study aims to explore women's perception of continuity of team midwifery care in Iran. METHODS: This research is a qualitative study conducted in Iran to explore women's perception of continuity of team midwifery care during pregnancy, birth and postpartum from October 2019 to August 2020. Fifteen semi-structured interviews were conducted with women individually in private midwifery clinic through a purposive sampling method. Interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis. RESULTS: From the data analysis, two themes, four main categories, and nine subcategories emerged. The themes were "Maternal empowerment" and "Mother's satisfaction during the transition from pregnancy to motherhood". The first theme included two categories of improving self-efficacy during antenatal education classes and the effective midwife-mother interaction. The second theme composed of two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood. CONCLUSION: Findings of this qualitative study highlight the effectiveness of continuity of team midwifery model of care for promoting empowerment and satisfaction in women during pregnancy, birth and postpartum. The results of this study could pave the way for developing, introducing and implementing the midwife-led continuity models of care in Iran.

The effect of Quercus (Oak Gal) vaginal cream versus metronidazole vaginal gel on bacterial vaginosis: A double­blind randomized controlled trial.

OBJECTIVE: This study was aimed to compare the effect of an Oak Gall extract­based cream and a metronidazole Gel on the bacterial vaginosis among women in reproductive age. MATERIAL AND METHODS: This was a double-blind, randomized controlled trial performed on 84 women with BV in reproductive age. Accordingly, the women were randomly assigned to the Oak Gall (n = 42) or metronidazole (n = 42) groups. Diagnosis of BV was confirmed when at least 3 of the 4 Amsel criteria were met by the participants (whitish-grey or thin homogeneous discharge, pH ≥ 4.5, the release of a fishy odor on the addition of 10 % KOH, and detection of clue cells > 20 % in the microscopic examination). For each group, either a methanol extract of Oak Gall vaginal cream or a metronidazole vaginal gel (5 g) was used as intravaginal for 5 consecutive days, and all the signs or symptoms were assessed by passing 4-7 days from the treatment completion. RESULTS: At baseline, the two groups were homogenous in terms of the vaginal burning, odor, dysuria, dyspareunia, and itching. Also, all women in both groups were free of symptoms (vaginal itching and burning sensation, bad odor, dysuria, and dyspareunia) by passing one week from the intervention (p < 0.001). The percent of bacterial vaginosis treatment was in 33(82.1 %) patients in terms of Oak Gall group and in 34(87.5 %) patients of Metronidazole group (p=0.56). Notably, Oak Gall was as effective and safe as metronidazole in the treatment of BV in reproductive-aged women. CONCLUSION: Oak Gall could be recommended for women in reproductive age who are uncomfortable with the potential side effects of synthetic drugs.

Impact of Glycyrrhiza glabra (licorice) vaginal cream on vaginal signs and symptoms of vaginal atrophy in postmenopausal women: A randomized double blind controlled trial.

BACKGROUND: Vaginal atrophy is one of the most common menopausal complications affecting women's quality of life. The present study aimed to investigate the impact of Glycyrrhiza glabra (licorice) vaginal cream on vaginal signs and symptoms of vaginal atrophy in postmenopausal women. METHODS: This randomized controlled trial was conducted on 70 menopausal women, referring to health centers of Izeh city, located in the south west of Iran, from May to November 2017. The participants with vaginal atrophy were randomly assigned into two groups of 35. One of the groups received licorice 2% vaginal cream while the other was given placebo over a period of 8 weeks. Data were analyzed using SPSS software at the significance level of 0.05. RESULTS: The results indicated that at the baseline, none of the subjects (0%) in either groups had a vaginal cells maturation Index within 65-100 in MVI category. However, after 8 weeks of therapy, it improved significantly to 82.9% in Licorice group and 11.4% in the placebo group (p < 0.001).Also, the vaginal mucus cells changed from the baseline cells to intermediate and superficial cells within and between the two groups after the treatment (p < 0.001). Finally, the pH level significantly decreased in licorice group over time (p < 0.001). CONCLUSION: Therapeutic use of licorice vaginal cream can improve the signs and symptoms of vaginal atrophy in postmenopausal women. Accordingly, use of licorice as a natural vaginal cream in vaginal atrophy can be suggested.

The effect of education through mobile phone short message service on promoting self-care in pre-diabetic pregnant women: A randomized controlled trial.

INTRODUCTION: Gestational diabetes is increasing in developed and developing countries. This study aimed to evaluate the effect of SMS messaging on the self-care among pre-diabetic pregnant women. METHODS: This randomized controlled trial conducted on 100 pre-diabetic pregnant women referred to Ahvaz Health Centers, Iran, Sep to Dec, 2016. Women were randomly assigned into the face to face education group and short message systems in addition to the face to face education group. Self-care variables were compared between the groups. Data was analyzed using chi-square, independent and paired t-tests. RESULTS: There was no difference regard to FBG and OGTT, but there was a significant difference between groups in physical activity level (P<0.001) and in all food groups except bread and cereals after the intervention (P<0.05). CONCLUSION: The education through a short text message system seem couldn't control the blood sugar, but it could promote physical activity and food additives of pre-diabetic pregnant women.

Molecular Characterization of Fasciola and Dicrocoelium Species Isolated from Ruminant Livestock in Qazvin, Iran.

INTRODUCTION: Fascioliasis and dicrocoeliasis are the most frequent zoonotic diseases with increasing human health problems in different parts of Iran. Two species, Fasciola hepatica (F. hepatica) and Fasciola gigantica (F. gigantica), are spread in the country. Molecular approaches have a decisive role in identifying both the species. The aim of this study was to detect Fasciola spp. and Dicrocoelium spp. by amplifying the ITS-2 and 28S rDNA gene sequence. METHODS: Overall, 30 infected liver samples were collected from the livestock of Qazvin, Iran. The adult flukes were collected from different livestock. DNA extraction and PCR amplification of ribosomal RNA gene region (ITS2) and 28S rDNA gene fragment were conducted and a phylogenetic tree was constructed. RESULT: All the isolates obtained from the cattle (No: 7) and 82.6% (No: 19) of sheep isolates were infected with F. hepatica species, whereas 17.4% (No: 4) of sheep isolates were infected with F. gigantica. It was also shown that F. hepatica was the predominant species of Fasciola present in the region. All the specimens were infected with Dicrocoelium dendriticum (D. dendriticum). CONCLUSION: Both the species of Fasciola were found in Qazvin. D. dendriticum was the sole infecting species of the Dicrocoelium genus in the livestock of the city of Qazvin. Further research studies are needed to determine the intermediate host of the parasites in the region.

The effect of curcumin-based and clotrimazole vaginal cream in the treatment of vulvovaginal candidiasis.

BACKGROUND: Vulvovaginal candidiasis (VVC) is the second most common infection of the lower female genital among women passing through their productive age. Furthermore, Candida albicans is the most common VVC agents followed by, non-albicans Candida species. Nowadays, extensive studies are being conducted on alternative therapies and the use of herbal medicines. OBJECTIVES: The present study was conducted to compare the effect of curcumin and clotrimazole vaginal cream in the treatment of VVC. METHODS: The present randomized controlled trial study was performed on 94 women passing through their productive age after their being diagnosed with VVC. The subjects were randomly divided into two groups, with one receiving curcumin-based vaginal 10% cream and the other receiving clotrimazole vaginal 1% cream. The treatment period was 1 week and a full 5 g applicator was used every night. Required follow-up was implemented 4-7 days after the end of treatment. RESULTS: The results showed no significant differences between the two groups in terms of vaginal discharge, itching, vulvovaginal irritation, and vulvovaginal erythema (P > 0.05); however, the number of negative cultures in the group receiving curcumin was significantly lower in comparison with the other group, which received clotrimazole (P = 0.002). CONCLUSION: It seems that although curcumin could be effective in the treatment of clinical symptoms of VVC, it, quite similar to clotrimazole vaginal cream, did not affect vaginal culture.

Translation and Cultural Adaptation of the Childbirth Experience Questionnaire (CEQ) in Iran.

BACKGROUND: A standardized method to measure and quantify women's birth experiences is required to study satisfaction of childbirth care. Therefore, this study aimed to translate and culturally adapt the Childbirth Experience Questionnaire (CEQ) for use in Iran. MATERIALS AND METHODS: This was a cross-sectional study including 203 women who attended 2 hospitals and 2 health centers and met the inclusion criteria in Ahvaz city, between February 2013 and June 2014. After forward and backward translation of the Swedish CEQ into Persian language, content validity was assessed by an expert panel. Scale reliability (internal consistency and test-retest reliability) was assessed with respect to the psychometric properties of the scale. RESULTS: Minor cultural differences were identified and resolved during the translation process. One item was excluded. The intraclass correlation coefficient ranging from 0.63 to 0.90 was satisfactory. CONCLUSIONS: The Persian version of the CEQ appears to be valid and reliable; hence, it can be an effective tool in designing childbirth experience interventions and also childbirth care and education interventions for the promotion of positive childbirth experience in Iranian women.

Psychometric properties of the Iranian version of mindful eating questionnaire in women who seeking weight reduction.

BACKGROUND: The aim of the present study was to test the validity, reliability and factor structure of the original Mindful Eating Questionnaire (MEQ) for use in an Iranian population. METHODS: This was a cross-sectional study conducted on 150 women who attended four athletic gyms and met the inclusion criteria in Ahvaz city in July of 2015. After linguistic validation of the Iranian version of the MEQ, the content validity ratio (CVR) and content validity index (CVI) were assessed by an expert panel. Then, exploratory factor analysis (EFA) was performed on the scale constructs and scale reliability (internal consistency and test-retest reliability) was assessed with respect to the psychometric properties of the scale. RESULTS: The CVR and CVI scores for the MEQ were 0.89 and 0.93, respectively. EFA loaded all 28-items with a 5-factor solution ('awareness', 'distraction', 'disinhibition', 'emotional response' and 'external cues') that jointly accounted for 53.78% of the observed variance. The results of the EFA supported the item 'When a restaurant portion is too large, I stop eating when I'm full' being placed in the external cues rather than the disinhibition subscale. This displacement improved the reliability coefficient for this subscale.The results of internal consistency analysis, including Cronbach's alpha (ranging from 0.73 to 0.81) and intraclass correlation coefficients (ranging from 0.73 to 0.91) were satisfactory. CONCLUSIONS: The Persian version of the MEQ appears to be valid and reliable; therefore, it can be an effective tool in designing mindfulness-based interventions for the treatment of individuals with eating disorders, overweight and obesity in an Iranian population.

Individual and Group Psycho-Educational Counseling on Knowledge, Attitude and Preference for Birth Method in Nulliparous Women: A Randomized Controlled Trial.

Objective: To study the effects of the Individual and Group Psycho-educational counseling in pregnant women on knowledge, attitude and mode of delivery. Materials and methods: This is a randomized controlled trial that carried out on 100 healthy nulliparous pregnant women with uncomplicated pregnancies, who had no contraindication for vaginal birth, but opted for a caesarean section in Medical centers of Dezful city, in the south west of Iran. Participants were randomly assigned into individual or group psycho-educational counseling from gestational week 20 and Knowledge, attitude and mode of delivery in the Individual and Group Psycho-educational counseling methods were measured. Results: All the participants (100%) in the individual and a majority (92%) in the group counseling changed their preference for birth method to vaginal birth after the counseling intervention. Baseline mean scores of knowledge and attitude into birth method selection were equal between groups. After the counseling intervention the mean scores increased significantly for knowledge in both the individual and group counseling groups: 12.96 and 12.88 before the intervention to 24.16 and 22.62, respectively (p < 0.001). Likewise attitude mean scores increased in both groups: 116.06 and 123.42, respectively, before the counseling sessions, that changed to 170.12 and 160.36 after the counseling sessions (p < 0.001). The differences in knowledge and attitude mean scores were statistically non-significant between groups after the intervention. Conclusion: The individual as well as the group psycho-educational counseling sessions increased the knowledge and attitude of pregnant women in relation to vaginal birth without significant differences between groups. Both methods can be recommended. A group counseling method is more effective for advising on the choice of delivery method when many women request a caesarean section without medical indications.

Development of a Questionnaire to Measure Attitude Toward Birth Method Selection.

BACKGROUND: The rate of mothers undergoing cesarean section in the absence of medical indication is increasing in the world. Women attitude have an essential role in the request or selecting a birth mode. This study aimed to develop a scale for measuring attitude toward birth method selection. MATERIALS AND METHODS: The study was conducted in two qualitative and quantitative parts. Data collection was conducted from June to December 2012 in Ahvaz, Iran. In the qualitative part of the study, 21 interviews were conducted with pregnant or parturient women and key informants. Consequently, content and face validity were performed to provide a pre-final version of the questionnaire. Then, in the quantitative part of the study, validity, exploratory factor analysis, and reliability were performed to assess the psychometric properties of the scale. RESULTS: A 130-item questionnaire was developed through the qualitative phase. It was reduced to an 82-item questionnaire after content and face validity. Exploratory factor analysis loaded a 68-item with an 8-factor solution ("beliefs and attitudes," "sexual and physical attitudes," "fear of childbirth," "preference of convenience, health, and supporting," "socio- cultural norms," "confidence to the birth practitioner," "personal and practical choice," and "sources of motivations," which jointly accounted for 42.97% of the observed variance. Cronbach's alpha coefficient showed excellent internal consistency (α = 0.87), and test-retest of the scale with 2-week intervals indicated an appropriate stability for the scale (0.89). CONCLUSIONS: The findings showed that the designed questionnaire was a valid and reliable instrument for indicating the pregnant womens' attitudes to their birth method selection. Also, ATBMS is an easy use questionnaire and contains the most significant factors persuading women to choose vaginal delivery or cesarean section.