Effect of implementation of the WHO intrapartum care model on maternal and neonatal outcomes: a randomized control trial.

BACKGROUND: In 2018, the World Health Organization published a set of recommendations for further emphasis on the quality of intrapartum care to improve the childbirth experience. This study aimed to determine the effects of the WHO intrapartum care model on the childbirth experience, fear of childbirth, the quality of intrapartum care (primary outcomes), as well as post-traumatic stress disorder symptoms, postpartum depression, the duration of childbirth stages, the frequency of vaginal childbirth, Apgar score less than 7, desire for subsequent childbearing, and exclusive breastfeeding in the 4 to 6 weeks postpartum period (secondary outcomes). METHODS: This study was a randomized controlled trial involving 108 pregnant women admitted to the maternity units of Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were allocated to either the intervention group, which received care according to the ' 'intrapartum care model, or the control group, which received the' 'hospital's routine care, using the blocked randomization method. A Partograph chart was drawn for each participant during pregnancy. A delivery fear scale was completed by all participants both before the beginning of the active phase (pre-intervention) and during 7 to 8 cm dilation (post-intervention). Participants in both groups were followed up for 4 to 6 weeks after childbirth and were asked to complete questionnaires on childbirth experience, postpartum depression, and post-traumatic stress disorder symptoms, as well as the pregnancy and childbirth questionnaire and checklists on the desire to have children again and exclusive breastfeeding. The data were analyzed using independent T and Mann-Whitney U tests and analysis of covariance ANCOVA with adjustments for the parity variable and the baseline scores or childbirth fear. RESULTS: The average score for the childbirth experience total was notably higher in the intervention group (Adjusted Mean Difference (AMD) (95% Confidence Interval (CI)): 7.0 (0.6 to 0.8), p < 0.001). Similarly, the intrapartum care quality score exhibited a significant increase in the intervention group (AMD (95% CI): 7.0 (4.0 to 10), p < 0.001). Furthermore, the post-intervention fear of childbirth score demonstrated a substantial decrease in the intervention group (AMD (95% CI): -16.0 (-22.0 to -10.0), p < 0.001). No statistically significant differences were observed between the two groups in terms of mean scores for depression, PTSD symptoms, duration of childbirth stages, frequency of vaginal childbirth, Apgar score less than 7, and exclusive breastfeeding in the 4 to 6 weeks postpartum (p > 0.05). CONCLUSION: The intrapartum care model endorsed by the World Health Organization (WHO) has demonstrated effectiveness in enhancing childbirth experiences and increasing maternal satisfaction with the quality of obstetric care. Additionally, it contributes to the reduction of fear associated with labor and childbirth. Future research endeavors should explore strategies to prioritize and integrate respectful, high-quality care during labor and childbirth alongside clinical measures.

Effect of hope therapy on psychological well-being of women after abortion: a randomized controlled trial.

BACKGROUND: Giving a healthy birth plays a vital role in a person's personality development, but giving unhealthy birth and abortion can increase the risk of a range of mental disorders and psychological harms including reduced well-being and quality of life. Psychological interventions can reduce the problems of individuals, so the present study was conducted to evaluate the effect of counseling with hope therapy on psychological well-being (primary outcome) and quality of life (secondary outcome) of women with an experience of abortion. METHOD: This randomized controlled trial was conducted in Alzahra and Taleghani educational and medical centers in Tabriz, Iran, on 52 women aged 16 years and above whose pregnancies led to abortion in 2020-21. Participants were assigned to intervention and control groups using random blocking method. The intervention group received counseling with hope therapy approach in 8 sessions of 45 min twice a week. The psychological well-being and WHO Quality of Life (WHOQOL) questionnaires were completed before the intervention and immediately and 4 weeks after the intervention. Independent t-test and repeated measures ANOVA were used to compare the outcomes in two groups. RESULTS: After the intervention based on the repeated measures ANOVA test and by adjusting the baseline score, the mean total score of psychological well-being in the counseling group was significantly higher than that in the control group (adjusted mean difference (AMD): 76.76; 95% confidence interval (95% CI): 63.81 to 89.70; P < 0.001). Also, the mean total score of quality of life in the counseling group was significantly higher than in the control group (AMD: 7.93; 95% CI: 6.38 to 9.46; P < 0.001). The mean score of all sub-domains of psychological well-being and quality of life in the counseling group was significantly higher than that in the control group (P < 0.05). CONCLUSION: Using hope therapy can improve the psychological well-being and quality of life of women after abortion. However, further clinical trials are required before making a definitive conclusion. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N60 . Date of registration: 17 Dec 2020. Date of first registration: 20 Dec 2020.