The Effect of Prenatal Self-Care Based on Orem's Theory on Preterm Birth Occurrence in Women at Risk for Preterm Birth.

BACKGROUND: Preterm birth is increasing as a major cause of perinatal complications and mortality in Iran. The present study aimed to investigate the effect of prenatal self-care based on Orem's theory on preterm birth occurrence in women at risk for preterm birth. MATERIALS AND METHODS: The present clinical trial was conducted on 176 pregnant women at 24-26 weeks at risk for preterm birth in Mashhad, Iran, from December 2015 to October 2016. A multistage sampling method was used in this study. The intervention group (88 pregnant women) received individual self-care education but the control group (88 pregnant women) received only common prenatal care. RESULTS: There was a statistically significant difference between intervention and control groups in terms of preterm birth occurrence (6.80% vs 20.50%) (χ2 = 6.90, df = 1,p = 0.008). The incidence of preterm birth in the intervention group was approximately three times higher than that in the control group. CONCLUSIONS: Given that educational interventions could reduce the incidence of preterm birth, it is suggested that the women at risk for preterm birth are trained for prenatal self-care.

Effect of Positive Psychology Interventions on the Quality of Prenatal Care Offered by Midwives: A Field Trial.

BACKGROUND: The quality of prenatal care has been recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. This study examined the effect of positive psychology interventions on the quality of prenatal care offered by midwives. MATERIALS AND METHODS: This field trial was conducted on 60 midwives working in community health centers in Mashhad, Iran, from September 23, 2015 to March 20, 2016. Initially, centers No. 1 and No. 3 were selected via cluster sampling from among the five healthcare centers of Mashhad. Then, all subsidiaries of these centers were listed and assigned to intervention and control groups through simple random sampling. Thus, 60 midwives were randomly assigned to two equal intervention and control groups. The intervention, based on Seligman's Well-Being Theory, was presented weekly with homework in eight 2-h sessions. Before the interventions and immediately after the intervention, the Oxford Happiness Questionnaire (OHQ) and Ryff's Scales of Psychological Well-Being (SPWB) were completed by the midwives, and the Quality of Prenatal Care Questionnaire (QPCQ) was completed by two pregnant women for each midwife. RESULTS: After the intervention, the mean [Standard Deviation (SD)] score of the overall quality of prenatal care in the intervention group was significantly higher than that of the control group [mean (SD) = 1.51 (0.49) vs. 0.05 (0.21); t43,12= 18.7, p < 0.001]. CONCLUSIONS: It seems that improving the well-being of midwives through positive psychology interventions is effective on the quality of prenatal care provided by them.

Effect of positive psychology interventions on psychological well-being of midwives: A randomized clinical trial.

BACKGROUND: The psychological well-being of midwives is very important in the context of providing health services to two vulnerable groups of society, namely, mothers and infants. Therefore, the present study was conducted aiming to investigate the effect of positive psychological interventions on the psychological well-being of midwives. MATERIALS AND METHODS: The present study was a randomized clinical trial with pretest-posttest design along with a control group. The statistical population of the study included all midwives working in community health centers of Mashhad City, Iran, which were first selected through cluster sampling method from five health centers of the city, i.e. centers 1 and 3. Then, all centers and subsidiary bases of these centers were listed, and the centers and bases were divided into two groups of intervention and control by simple random allocation method. Sixty respondents were randomly assigned to two equal intervention and control groups and responded to the Ryff's Psychological Well-being questionnaire in two stages of pretest and posttest. Educational interventions based on interventions, including Seligman's PERMA model, in which psychological well-being is defined in terms of five domains namely positive emotions (P), engagement (E), relationships (R), meaning (M), and accomplishment (A), were conducted in eight sessions of 2 h (two sessions per week). Data were analyzed using independent t-test, paired t-test, Mann-Whitney test, and Wilcoxon test. RESULTS: There was a significant difference between the posttest scores of the two intervention and control groups in the total psychological well-being variable (P < 0.001). CONCLUSION: Given the findings of the study, it is suggested to use the Seligman's PERMA model to improve the psychological well-being of midwives in health centers.

Comparison of Rosemary and Mefenamic Acid Capsules on Menstrual Bleeding and Primary Dysmenorrhea: A Clinical Trial.

BACKGROUND: Primary dysmenorrhea is the most common complaint of women. Imbalance secretion of prostaglandin from the endometrium during menstruation cycle is effective in primary dysmenorrhea and menstrual bleeding. The aim of this study was to compare rosemary capsule and mefenamic acid on menstrual bleeding and primary dysmenorrhea. MATERIALS AND METHODS: This randomized double-blinded study was conducted on 82 students with primary dysmenorrhea in the Islamic Azad University of Mashhad in 2016. Participants had moderate dysmenorrhea and normal menstrual bleeding. No intervention was carried out at the two cycles. During the next two cycles, participants were randomly divided into two groups (rosemary and mefenamic acid(. Participants in the intervention group received 250 mg rosemary capsules and the control group received 250 mg mefenamic acid capsules in the first 3 days of menstruation. The visual analogue scale (VAS) was used to determine the severity of pain and Hingham chart to determine the amount of bleeding in menstruation. Independent t-tests, Mann--Whitney were used for statistical analysis. p < 0.05 was considered statistically significant. RESULTS: Pain intensity score standard deviation (SD) before and after intervention for rosemary group were 40.39 (11.41) and 23.57 (12.78) (t 41 = 9.90, p < 0.001). For the control group, they were 46.75 (13.32) and 28.29 (17.21) (t 39 = 9.10, p < 0.001). Menstrual bleeding score (SD) before and after intervention for rosemary group were 55.21 (21.32) and 46.30 (24.16) (t 41 = 2.60, p = 0.01). For the control group, they were 51.05 (23.87) and 43.43 (29.47) (t 39 = 2.10, p = 0.01). There was no statistically significant difference between the pain severity and menstrual bleeding score SD in these two groups. CONCLUSIONS: Rosemary capsules reduce the menstrual bleeding and primary dysmenorrhea the same as mefenamic acid capsules.

The effect of small group teaching on quality of life in pregnant women with nausea and vomiting: A clinical trial.

INTRODUCTION: Nausea and vomiting in pregnancy is the most common medical complication in the first trimester of pregnancy. That associated with a wide range of physical and mental symptoms for the patient and his family and can affect the quality of life of women's life. In addition, the training to improve knowledge, in adjusting diet and lifestyle, and leading to decrease nausea and vomiting. Due to the positive characteristics of training using the small groups, this study was applied with the objective of "The effect of small group teaching on quality of life in pregnant women with nausea and vomiting." METHODS: This study was applied based on intervention, on 59 nulliparous women with nausea and vomiting who referred to obstetrics ward of selected health and treatment centers in Neishaboor County. The training was presented by a researcher in group intervention in 8 sessions, each 45-30 min in small groups (3 groups 10 members). The control group received routine care. The study instruments (nausea and vomiting of pregnancy quality of life questionnaire) and (modified-PUGE) form. The results were analyzed using the Wilcoxon test, Mann-Whitney, and t-test. RESULTS: Research units were no statistically significant difference of personal data, at the beginning of the study, and before intervention, was not differences between the mean change scores of postpartum stress disorder in two groups (P = 0/192). While the mean quality of life score in the intervention and control groups was statistically significant difference after intervention (P = 0.001). Quality of life score in the intervention group had statistically significant difference before and after the intervention (P = 0.001). CONCLUSION: Training in the intervention group with small group strategies has more effective in comparison to conventional training of nausea and vomiting.

Comparing two instructional methods of role playing and lecture on primigravida females, decision about type of delivery.

INTRODUCTION: Each mother has the legal right to decide about her delivery, but this decision should be made based on scientific knowledge. Instructions during pregnancy help to choose the proper type of delivery. This study conducted aimed to compare two instructional methods of role playing and lecture on primigravida decision about type of delivery. SUBJECTS AND METHODS: In this single-blind clinical trial 67 primigravida, 34-36 week were selected using multi-stage sampling and assigned into two groups randomly. Decision-making (before, 2-week after, and at admission in maternity department) was tested by a questionnaire. In role-playing group, advantages and disadvantages of two type delivery were presented by role-playing in 90-min by three scenarios. In lecture group, it was also presented in a 90-min lecture. Data were analyzed by mean difference test, Fisher test, independent and paired t-test. RESULTS: Two groups showed a significant difference in terms of decision at admission to maternity department (P = 0.000). 75% of lecture group and 100% of role-playing group selected normal delivery. Postintervention knowledge score in lecture group was 18 ± 5.3 and in role-playing group 17.1 ± 4.0. Percent of change in knowledge scores in two groups was significant (P = 0.001). Participants' attitude, before and after the intervention, in both groups was significant (P < 0.05). Mean difference of pre- and post-test in relation to two groups' knowledge and attitude scores was not significant (P > 0.05). CONCLUSION: In this research, lecture was more effective in raising knowledge level, and role playing was more effective in raising decision to vaginal delivery and reducing elective caesarean section. It is therefore suggested to use both teaching methods altogether for pregnant women to decrease the rate of unnecessary cesarean.

The Association of Family Support After Childbirth With Posttraumatic Stress Disorder in Women With Preeclampsia.

BACKGROUND: Stressful situations and life-threatening issues such as preeclampsia can lead to Post-traumatic stress disorders [PTSD]. It seems that within social supports, family support has more effect on mental health. OBJECTIVES: The aim of this study was to determine the association between family supports in the postpartum period with occurrence of post-traumatic stress disorder following preeclampsia. PATIENTS AND METHODS: In this descriptive longitudinal study, 100 women with preeclampsia admitted in government hospitals of Mashhad were selected using convenience sampling. Post-traumatic stress disorder was diagnosed by psychiatrist interview and perinatal posttraumatic stress questionnaire (PPQ) in sixth week postpartum and family support was measured by family support scale (FSS) in second and sixth weeks postpartum. Data analyzed by SPSS 16 using Spearman correlation coefficient, paired sample T-test and Kruskal-Wallis test. RESULTS: A reverse significant association was found between family support in weeks 2 and 6 (92.6 ± 22.6, 83.7 ± 21.6, respectively) and PTSD (mean score of 4.8 ± 2.5) (respectively, P = 0.010 and P =0.011). The most important variables affecting PTSD with presence of family support in weeks 2 and 6 were postpartum depression in week 6 as well as trait anxiety at the time of admission. CONCLUSIONS: The more support in weeks 2 and 6 postpartum, the less PTSD occurs. Therefore, it is suggested to health care providers who face mothers after delivery to evaluate the support received by mothers and help those with inadequate or inappropriate support.

Depression and anxiety in pregnancy and postpartum in women with mild and severe preeclampsia.

BACKGROUND: Risk for anxiety and depression is increased in women with high-risk pregnancy. The aim of this study was to evaluate anxiety and depression in women with mild and severe preeclampsia at admission and 6 weeks postpartum. MATERIALS AND METHODS: In this cohort study, 122 preeclamptic women who were admitted to the Public hospital and Tamin Ejtemaee hospital of Mashhad were included. Selection was done by convenience sampling method. Beck Depression Inventory II (BDI-II) and Spielberger State-Trait Anxiety Inventory (STAI) were completed at admission and 6 weeks after delivery. Data were analyzed by SPSS 16 using Chi-square, Fisher's exact test, Mann-Whitney U test, and Repeated measurement. RESULTS: The mean depression score was 4.81 ± 4.09 at admission and 11.17 ± 5.5 at 6 weeks postpartum. The mean of trait anxiety was 42.5 ± 10.5 at admission and 32.3 ± 6.5 at 6 weeks postpartum, and the mean of state anxiety score at admission was 43.09 ± 9.5 and at 6 weeks postpartum was 31.99 ± 5.9. There was a significant difference between the scores of depression (F = 3.8, P < 0.001), state anxiety (F = 1.52, P < 0.001), and trait anxiety (F = 1.5, P < 0.001) at admission and 6 weeks postpartum. No significant differences were found between severity of preeclampsia and the scores of depression, state anxiety, and trait anxiety at admission and 6 weeks postpartum. CONCLUSIONS: The mean score of state and trait anxiety decreased significantly in preeclamptic women from admission to 6 weeks postpartum, but the mean score of depression increased. Severity of preeclampsia was not an independent risk factor of depression and anxiety.

The Effect of Acupressure on Sleep Quality in Menopausal Women: A Randomized Control Trial.

BACKGROUND: One of the common problems in menopausal women is sleep disorder. Traditional Chinese acupressure is a noninvasive and safe technique. Menopausal women can easily learn the technique and a self-care method to manage their sleep disorder. This study was carried out to evaluate the effectiveness of acupressure on sleep quality of postmenopausal women in Mashhad during 2009. METHODS: This double blind, randomized clinical trial was performed on 120 qualified menopausal women at the age of 41-65 years. Their sleep quality was measured according to the Pittsburgh Sleep Quality Index (PSQI). Participants were randomly assigned to an acupressure group (n=37), a sham acupressure group (n=36) and a control group (n=32) by two time randomized method (systematic and simple randomized). These interventions were carried out for four consecutive weeks. The participants in the acupressure and sham acupressure groups learned to carry out the acupressure technique as a self-care at home with simultaneous massage techniques that were to be performed 2 hours before sleep, whereas only conversation was used in the control group. The data were analyzed by the SPSS software version 17. RESULTS: The results indicated significant differences in total PSQI scores among the three groups (P<0.001). Tukey's test revealed that there were significant differences between the acupressure group and the control group (P<0.001), the acupressure group and sham acupressure group (P<0.001), and the sham acupressure and the control group (P<0.001). CONCLUSION: Acupressure can be used as a complementary treatment to relieve sleep disorders in menopausal women; and is offered as an efficient method to manage sleep quality. TRIAL REGISTRATION NUMBER: IRCT2013100614910N1.

Effect of role play education on primiparous women's fear of natural delivery and their decision on the mode of delivery.

BACKGROUND: The number of women who select cesarean section due to fear of childbirth has increased. Role play education seems to be a helpful method to remove or reduce the fear of childbirth. Therefore, this study aimed to investigate the effect of role play education on primiparous women's fear of natural delivery and their decision on the mode of delivery. MATERIALS AND METHODS: In this blind clinical trial, 67 primiparous women with natural pregnancy at 34-36 weeks of gestational age and with no indication of cesarean section were selected from the health care centers in Mashhad. They were randomly assigned to two groups who underwent pre-test and post-test with the help of delivery attitude questionnaire to investigate their fear of childbirth and a researcher-made pregnant women's decision investigation questionnaire. Education through role play was conducted in the form of three scenarios during seven stages. The findings were analyzed by Fisher's exact test and independent t-test through SPSS. RESULTS: The two groups were significantly different concerning the fear of childbirth after the intervention (P = 0.007), and the fear score showed a higher reduction in the role play group compared to the lecture group. There was a significant difference between the two groups concerning the reduction of elective cesarean section and the decision on the mode of delivery at the time of admission in the labor room (P = 0.000). About 75% in the lecture group and 100% in the role play group selected natural delivery. CONCLUSIONS: In the present study, the effect of role play was more in making a decision on natural delivery, reducing the fear of childbirth, and reducing the rate of elective cesarean section. It is suggested to use role play method to educate pregnant women to reduce the rate of cesarean sections.