Midwives' experience of respectful maternity care (RMC) globally: A meta-synthesis.

BACKGROUND: Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them. METHOD: For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' perceptions of RMC written between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined. RESULT: There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives' conceptualizations of RMC, Midwives commitment to woman's rights, The value and impact of RMC to midwives, Midwife's perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives' recommendations for optimal RMC practice. CONCLUSION: In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required.

Implementation of birth plans integrated into childbirth preparation classes for vaginal birth: a qualitative study of women, their husbands and clinicians' perspectives in Iran.

BACKGROUND: Understanding women's experience of birth planning is necessary for introducing and implementing this process in the Iranian maternity services. This study aims to explore perceptions of birth plan implementation in Iran from the perspective of women, their husbands, and clinicians. METHODS: This qualitative study was conducted in Iran. Qualitative data were collected from November 2020 to March 2021 by conducting semi-structured in-depth interviews with ten mothers who prepared a birth plan, and 15 key informants (obstetricians, midwives, and husbands) who were involved in the implementation process of birth plans. Data were analyzed using conventional qualitative content analysis. RESULTS: Data reduction process resulted in 380 codes that were categorized in 16 subcategories and five main categories. The main categories were "Guide and pattern of preparing for childbirth pathway", "Maternal empowerment and sense of triumph", "Facilitating and enhancing communication", "Successful transition to parenthood and women's satisfaction", and "Challenges associated with implementation of the birth plan". The overarching theme "Birth plan: The missing link in promotion of vaginal birth in Iran" was constructed from these categories. CONCLUSION: Findings of this study highlight the effectiveness of the implementation of birth plan along with childbirth preparation classes for increasing the likelihood of a successful vaginal birth and promoting empowerment and satisfaction in women during the childbirth process. The findings of this study could pave the way for developing, introducing, and implementing of birth plan in Iran.

Development of accreditation standards for midwifery clinical education in Iran.

BACKGROUND: Accreditation is one of the most important methods of quality assurance and improvement in medical education. In Iran, there are no specific midwifery education accreditation standards. This study was designed to develop accreditation standards for midwifery clinical education in Iran. METHODS: This study was performed in Iran in 2021. It consisted of two phases. In the first phase, accreditation standards for midwifery education in the United Kingdom, the United States, Australia and the International Confederation of Midwives were thoroughly examined through a narrative review. The domains obtained from this phase were used as a framework for coding in the second phase. In the second phase, a qualitative study was conducted with a directed content analysis approach to determine standards and criteria for clinical midwifery education accreditation in Iran. Participants were policymakers and senior managers of midwifery education, faculty members of midwifery departments with clinical teaching experience, and final year undergraduate midwifery students. The participants were selected by purposive sampling method, and data collection continued until data saturation. RESULTS: The standards and accreditation criteria of midwifery education from the review study were formed 6 domains: Mission and goals; Curricula; Clinical instructors; Students, Clinical setting; and Assessment. In the second phase, data analysis led to the extraction of 131 codes, which were divided into 35 sub-subcategories, 15 sub-categories, and 6 main categories. CONCLUSION: Implementing the specific and localized standards of clinical midwifery education in Iran can lead to improved quality of clinical education programs.

A phenomenological study of the experience of domestic violence in Iranian women with HIV.

This study explores the lived experience of domestic violence in HIV-infected women in Iran using a qualitative phenomenological approach. Data were collected in 2014 through in-depth interview of twelve HIV-infected women purposefully selected from a counselling centre in Tehran. The qualitative data were analysed using a thematic analysis approach. The main theme that emerged was 'the sunset of life' - an emotional numbing and fragile marital relationship resulting from the violence suffered by the women. From this, three sub-themes expressing women's feelings of hopelessness were extracted: 'the destroyed life', 'being in the destiny prison' and 'living on the edge of annihilation'. The results revealed that although the experience of domestic violence had devastating effects on women's lives, HIV infection was the factor that forced them to remain trapped in violent relationships. The findings emphasize the importance of designing comprehensive violence prevention strategies tailored to meeting the needs of HIV-infected women in Iran.

Investigating the relationship between organizational health and burnout and job stress among midwives working in hospitals in 2020.

BACKGROUND: Despite the prominent role of midwives in improving the health of women and families, limited studies have been conducted in the occupational and organizational field and their role on the performance of this group. The purpose of this research is to investigate the relationship between organizational health, burnout, and job stress among midwives working in hospitals affiliated to Shahrekord University of Medical Sciences. MATERIALS AND METHODS: The present study is a cross-sectional descriptive-analytical study, which was conducted with available sampling method on 159 midwives working in hospitals affiliated to Shahrekord University of Medical Sciences in 2020. Data collection tools were: Demographic Questionnaire, Modified Hoy and Feldman Organizational Health Questionnaire, Job Stress Questionnaire, Maslach Questionnaire to measure job burnout. Finally, the obtained data were analyzed with descriptive and analytical statistical tests (Pearson). RESULTS: The findings of the study showed that 70.4% of the participants had moderate to severe job stress and 70.4% of the participants had moderate level of organizational health and 79.9% suffered from job burnout. The results of structural equations showed that organizational health has an inverse and significant relationship with job stress (P < 0.001, ß = -0.45) and job burnout (P = 0.002, ß = -0.33). CONCLUSION: Organizational health has an inverse and significant relationship with job stress and job burnout. The findings of this study can be useful in planning and organizational policies for midwifery professionals. It also conveys the importance of extensive studies and planning to reduce stress and burnout and then improve organizational health. As a result, it can improve the performance and productivity, and as a result, improve the health of midwives and patients under their care and, consequently, the health of the society.

Domestic violence against Iranian women during the Covid-19 lockdown: A cross-sectional study.

Background and Aims: Despite the fact that public health measures such as social isolation can help control the coronavirus disease 2019 (Covid-19) pandemic, these procedures may contribute to elevated levels of stress and escalate various forms of violence against women. The current study aimed to estimate the prevalence of domestic violence and identify factors associated with domestic violence during the Covid-19 lockdown among married women attending healthcare centers in Iran. Methods: This cross-sectional study, conducted between 2020 and 2021, focused on a sample of 5317 married women who sought healthcare services within urban centers across five major cities in Iran. Sampling was done through a multistage cluster method. The Revised Conflict Tactics Scales (CTS2) were used to assess levels of violence. The collected data was analyzed using descriptive and inferential statistics, including independent sample t-test, Chi-square, and multiple logistic regression) with the SPSS software version 22. Results: During the Covid-19 lockdown, psychological violence was reported by 66.7% of women (95% confidence interval [CI], 65.44%-67.98%), physical violence by 44.8% (95% CI, 43.43%-46.10%), sexual violence by 28.8% (95% CI, 27.60%-30.03%), and injury by 24.5% (95% CI, 23.39%-25.70%). The multiple logistic regression showed several significant factors associated with domestic violence. These included low levels of social support (p < 0.001), shorter duration of marriage (p < 0.001), unemployment of both women (p < 0.007) and their spouses (p < 0.001), poor economic status (p < 0.001), as well as substance abuse by the husband, including alcohol (p < 0.001) and drug abuse (p < 0.01), and smoking (p < 0.01). Conclusion: The findings highlighted the magnitude of domestic violence against women during the Covid-19 lockdown. It is crucial to implement comprehensive strategies that encompass preventive and responsive measures to address domestic violence not only during lockdowns but also in the post-lockdown period.

Effect of birth plans integrated into childbirth preparation classes on maternal and neonatal outcomes of Iranian women: A randomized controlled trial.

Background: Involvement of women in the decision-making process during childbirth plays an important role in their physical and psychosocial preparation. A birth plan allows the woman to express her expectations and facilitates her participation in her own care. The present study is the first to assess the implementation of birth plans integrated into childbirth preparation classes in Tehran, Iran. Methods: This study is a randomized controlled clinical trial performed on 300 pregnant women at 32-33 weeks of gestation referring to four public health centers in Tehran, Iran. The participants were randomly allocated into intervention and control groups using block randomization method. A training session on the items of the birth plan checklist was held in the fifth session of childbirth preparation classes for the participants in the intervention group. Accordingly, a birth plan was prepared according to the requests of mothers. The birth plan was implemented after the women were admitted to the maternity ward. The primary outcomes were frequency of vaginal birth, mean duration of labor stages, and mean score of childbirth satisfaction. We used a checklist of maternal and neonatal outcomes, Mackey's childbirth satisfaction questionnaire, and a partogram form for data collection. Independent t-test, Mann-Whitney U-test, Chi-square test, Fisher's exact test, and logistic regression were used for data analysis. Results: Vaginal birth rates were significantly higher in women who had birth plans compared with those without (81.9% vs. 48.7%, p < 0.001). Also, the lengths of the first and the second stages of labor were significantly shorter in women having a birth plan (p = 0.02). Women in the birth plan group were significantly more satisfied with the process of labor and childbearing (p < 0.001), and started breastfeeding after birth earlier than those in the control group (p < 0.001). Conclusion: Having a birth plan and attending childbirth preparation classes can increase the rate of normal vaginal birth. Also, according to our results, women's participation in the decision- making process and fulfilling their preferences during birth can improve maternal and neonatal outcomes and childbirth satisfaction.Trial registration: IRCT20190415043283N2. 2020-12-07.

The effect of auriculotherapy on improving sleep quality in postmenopausal women aged 45-60 years: A clinical trial study.

BACKGROUND: Menopause is one of the developmental stages of women. One of the most common problems during this period is sleep disorders. Sleep disorders can affect the quality of life of these people. To improve sleep disorders, auriculotherapy has received less attention due to its low cost and effectiveness, and side effects. Therefore, the aim of this study was to determine the effect of auriculotherapy on improving sleep quality in postmenopausal women aged 45-60 years. MATERIALS AND METHODS: The present study is a clinical trial study that was performed on 82 postmenopausal women aged 45-60 years under the auspices of health centers in Mahshahr city, Iran from 2021-2022. Women with inclusion criteria were randomly divided into two groups (intervention and control). The intervention group underwent auriculotherapy for 4 weeks. The St. Petersburg Sleep Quality Questionnaire was completed by both groups at the beginning and 4 weeks after the start of the intervention. Finally, the data were analyzed by SPSS software version 22 and independent t-test, paired t-test and Chi-square test. RESULTS: At the beginning of the study, both groups were homogeneous in terms of demographic variables. The results of data analysis using independent t-test showed that before the intervention, mental quality (P = 0.513), length of incubation period (P = 0.285), sleep duration (P = 0.121), sleep efficiency (P = 0.513), sleep disorders (P = 0.685), use of sleeping pills (P = 0.530), daily functioning (P = 0.60), and overall sleep quality score (P = 0.30) in the control and intervention groups were not statistically significant. However, comparing the mean scores after the intervention in the control and intervention groups showed that mental quality (P < 0.001), incubation period (P < 0.001), sleep duration (P < 0.001), sleep efficiency (P < 0.001), sleep disorders (P < 0.001), use of hypnotics (P = 0.002), daily functioning (P = 0.001), overall sleep quality score (P < 0.001), sleep duration (P = 0.822), sleep efficiency (P = 0.889), sleep disorders (P = 0.889), use of sleeping pills (P = 1.00), daily performance (P = 0.767), overall sleep quality score (P = 0.69) were statistically significant between the two groups. In-group comparison using paired t-test in the control group showed that mental quality (P = 0128), length of the incubation period (P = 1.00), and before and after the intervention did not differ significantly in the mean scores. However, a within-group comparison in the intervention group showed that mental quality (P < 0.001), incubation period (P < 0.001), sleep duration (P < 0.001), sleep efficiency (P < 0.001), sleep disorders (P = 0.003), use of sleeping pills (P = 0.007), daily functioning (P < 0.001), and overall sleep quality score (P < 0.001) before and after the intervention had a significant difference in the mean scores. CONCLUSION: The results showed that auriculotherapy has significant effectiveness in improving the quality of sleep, and its dimensions and can be used as an effective method in this area that can be implemented at a low cost and easily. According to reports from participants and previous studies in this field, auriculotherapy did not have any side effects and can be used as a safe way to improve sleep quality.

The Effect of Malva Sylvestris Cream on Episiotomy Pain and Healing: A Randomized Controlled Clinical Trial.

Background: Episiotomy is one of the common procedures during childbirth in Iran, which causes pain, discomfort, and scar in the perineum. This study aimed to pursue the effect of Malva Sylvestris cream on episiotomy pain and healing. Methods: This study was a double-blinded randomized-controlled clinical trial that was conducted from April to December 2021 at the Sina hospital in Ahvaz, Iran. Sixty women were selected and randomly assigned to control and intervention groups using block randomization. The main outcomes included pain assessment and episiotomy wound healing that are assessed by the Visual analog scale (VAS), and perineal healing scale included redness, edema, ecchymosis/bruising, discharge, approximation (REEDA). The cream was used twice a day for up to 14 days. The participants were followed on the first, seventh, and fourteenth days postpartum. Independent T-test, Mann-Whitney, and Chi-square, and Generalized Estimating Equations (GEE) model were used by SPSS software version 22 for data analysis. Statistically significant level was considered less than 0.05. Results: There were no significant statistical differences between the two groups in demographic characteristics (P>0.05). No significant statistical differences were found in both groups in terms of perineal healing (B=-0.05; P=0.89) and pain scores (B=0.15; P=0.56). However, the chance of external dysuria in the intervention group decreased by 77% (P=0.01). Conclusion: Despite showing the positive effect of Malva Sylvestris extract on wound healing in animal and in-vitro studies, this clinical study failed to show the positive effect of this extract on wound healing and pain relief of episiotomy. However, future clinical trials are needed to substantiate the above findings.Trial Registration Number: IRCT20190826044621N1.

Investigation the effect of jujube seed capsule on sleep quality of postmenopausal women: A double-blind randomized clinical trial.

BAKGROUND AND OBJECTIVE: Sleep disorder is among the most common problems in the life of postmenopausal women. Because of the complications of chemical drugs, many women prefer to use herbal supplements for relieving sleep problems. So, the main objective of this study was to determine the effect of the jujube seed capsule on sleep quality in postmenopausal women. MATERIALS AND METHODS: This study was a double-blind clinical trial conducted on 106 postmenopausal women in Khuzestan province, southwest of Iran. All participants were selected by a simple non-probability sampling method. Data were collected through a demographic data form and the Pittsburgh sleeps quality index (PSQI). Individuals were randomly divided into intervention (n = 53) and control (n = 53) groups. The intervention group received 250 mg oral jujube seed capsule and the control group received a placebo capsule twice a day for 21 days. After the treatment, the PSQI was completed in both intervention and control groups. Data were analyzed using the independent t-test and the Chi-square test using SPSS software version 24, and p-value < 0.05 was considered as the significance level. RESULTS: The results revealed that after treatment, the mean scores of sleep quality decreased in the intervention and control group. Although this difference was statistically significant in both intervention and control groups (p-value < 0.05), more reduction observed in the intervention group (p-value < 0.001). CONCLUSION: Consumption of the jujube seed capsule had a positive impact on improving the sleep quality of postmenopausal women and could be recommended as a useful herbal medication.

Iranian pregnant teenage women tell the story of "fast development": A phenomenological study.

BACKGROUND: Teenage pregnancy is a major health problem significantly associated with negative impacts on the health of both teenage mothers and their newborn. However, little is known about teenage pregnancy from teenager's perspective, particularly in developing countries including Iran. AIM: This study aimed to explore the experience of pregnancy in Iranian teenage women. METHODS: An interpretive phenomenological study was used as a suitable research design to conduct this research. Data were collected through individual, semi structured and in-depth interview with 11 married teenage women aged between 15 and 19 years old, primigravida with singleton pregnancy. Data were analysed through thematic analysis approach. FINDINGS: "Fast development" was the main theme that emerged from the participants' experiences. It refers to the unexpected development process that occurs simultaneously with other important development events. Fast development consists of three themes, 'unexpected development', 'development within development', and 'struggle with development'. CONCLUSION: Teenage pregnant women simultaneously encounter multiple developmental challenges related to adolescence period, marriage, pregnancy, and mothering responsibilities. According to the results, fast development concept should be considered by healthcare providers in order to offer comprehensive and age-appropriate health services to pregnant teenage women for successful transition from the multiple developmental stages. Moreover, this concept will help health care providers, especially midwives, to understand how to deal with pregnant teenagers.

Determinants of Early Marriage from Married Girls' Perspectives in Iranian Setting: A Qualitative Study.

Early marriage is a worldwide problem associated with a range of health and social consequences for teenage girls. Designing effective health interventions for managing early marriage needs to apply the community-based approaches. However, it has received less attention from policymakers and health researchers in Iran. Therefore, the current study aimed to explore determinants of early marriage from married girls' perspectives. The study was conducted from May 2013 to January 2015 in Ahvaz, Iran. A purposeful sampling method was used to select fifteen eligible participants. Data were collected through face-to-face, semistructured interviews and were analyzed using the conventional content analysis approach. Three categories emerged from the qualitative data including "family structure," "Low autonomy in decision-making," and "response to needs." According to the results, although the participants were not ready to get married and intended to postpone their marriage, multiple factors such as individual and contextual factors propelled them to early marriage. Given that early marriage is a multifactorial problem, health care providers should consider a multidimensional approach to support and empower these vulnerable girls.

Domestic Violence During Pregnancy and Women's Health-Related Quality of Life.

Domestic violence during pregnancy is a major health problem with significant psychological and physical impairments for pregnant women. To assess the relationship between domestic violence during pregnancy and women's health-related quality of life (HRQoL), a cross-sectional study was conducted on 341 postnatal women who referred to urban health care centers in Gachsaran, Islamic Republic of Iran. Domestic violence was assessed using a questionnaire modified from the Abuse Assessment Screen (AAS), and Iranian version of Short Form-36 questionnaire was used to assess women's HRQoL. The findings of the study showed 44.5% of women reported experiencing domestic violence during pregnancy. All the SF-36 subscales including both physical and mental health dimensions scored lower in the abused women compared to the non-abused women, and differences between the groups in the six subscales of SF-36 except 'physical functioning' and 'bodily pain' were statistically significant (P<.05). These results suggest that domestic violence during pregnancy is associated with poor HRQoL in abused women.