Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study.

BACKGROUND: In recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of "Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model". METHODS/DESIGN: The current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants' attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants' average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method. DISCUSSION: This is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably. ETHICAL CODE: IR.MUMS.NURSE.REC. 1403. 014.

In recent decades, medical management of the labor and delivery process has extended beyond its limitations to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. The global midwifery situation indicates that one in every five women worldwide gives birth without the support of a skilled attendant. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. In industrialized countries, maternal and infant mortality rates have decreased over the past 60 years due to medical or social reasons. So far, the policies and programs of the Ministry of Health to diminish medical interventions and cesarean section rates have not been successful. Midwifery models in hospital care contain midwives who support women's choices and diverse ideas about childbirth on the one hand, and on the other hand, they must adhere to organizational guidelines as employees, primarily based on a medical and pathological approach rather than a health-oriented and midwifery perspective. Therefore, the current study aims to be conducted with the purpose of "Designing a midwifery-led birth centered maternity program based on the MAP-IT model". It is a Model for Implementing Healthy People 2030, (Mobilize, Assess, Plan, Implement, Track), a step-by-step method for creating healthy communities. Using MAP-IT can help public health professionals and community changemakers implement a plan that is tailored to a community's needs and assets.

Explaining the perception and experiences of breastfeeding in mothers who have a high risk pregnancy: a protocol study.

INTRODUCTION: Enhancing breastfeeding practices, even in affluent nations, significantly reduces child mortality rates. Nevertheless, three out of five newborns do not receive breastfeeding within the first hour of birth. Research indicates that under high-risk pregnancy circumstances, there may be challenges in initiating and sustaining breastfeeding. Infants born from high-risk pregnancies are particularly vulnerable to illnesses and mortality. Although breastfeeding serves as a protective measure against various infant and post-infancy ailments, many mothers encounter difficulties in commencing or maintaining breastfeeding due to complications associated with their conditions. The present study aims to illuminate the understanding and experience of breastfeeding in mothers with high-risk pregnancies, considering the cultural and social context of Iran. METHOD: This study is a qualitative research utilizing a conventional content analysis approach. In this qualitative study, mothers who have undergone a high-risk pregnancy and currently have infants under 6 months old will be chosen through purposeful and snowball sampling. Their breastfeeding experiences will be gathered through individual, semi-structured, and face-to-face interviews. In addition to interviews, observation and focus groups will also be used to collect data. Data analysis was performed using Graneheim and Lundman's method with MAXQDA software version 10, VERBI Software GmbH, Berlin. The study will utilize the criteria of Lincoln and Guba (1985) for validity and reliability. DISCUSSION: This qualitative study aims to investigate the experiences and challenges of breastfeeding in mothers with high-risk pregnancies to pinpoint breastfeeding barriers in this demographic and develop essential interventions and strategies to address these obstacles.

Understanding the meaning of the lived experience "maternal role" in women with multiple sclerosis and planning a supportive program: a combined exploratory study protocol.

BACKGROUND: The maternal role is one of the most challenging yet rewarding roles that women experience in their lives. It begins when a woman becomes pregnant, and as the pregnancy progresses, she prepares to fulfill her role as a mother. A woman's health plays a crucial role in her ability to fulfill the maternal role. Multiple sclerosis (MS), as an autoimmune disease, presents unique challenges in achieving this role. Failing to fulfill the maternal role can have lasting consequences for both the mother and the baby. Given the increasing number of women with MS of reproductive age in Iran and the absence of specific programs for this group during pregnancy and postpartum, researchers have decided to develop a supportive program by exploring the meaning of the maternal role and identifying the needs of these women during this period. METHODS/MATERIALS: This study will be conducted in 3 stages. The first stage involves a qualitative study to explore the meaning of the "maternal role" in women with MS through a descriptive and interpretive phenomenological approach based on Van Manen's method. Data will be collected through semi-structured interviews with pregnant women with MS and mothers with MS who have children under one-year-old, recruited from the Multiple Sclerosis Society of Mashhad, Iran. The second stage will involve designing a support program based on the findings of the phenomenological study, literature review, and exploratory interviews. A logical model will guide the development of the program, and validation will be conducted using the nominal group technique. DISCUSSION: This study is the first of its kind in Iran to explore the meaning of the maternal role and develop a support program for women with MS. It is hoped that the results of this study will help address the challenges of motherhood faced by these women.

The maternal role is considered one of the most significant roles a woman will undertake in her lifetime. It is a process in which a woman, as a mother, attains competency in her role and eventually becomes comfortable with her identity as a mother. However, there are various factors, such as diseases, that can impede a mother from fully embracing her role. Multiple sclerosis (MS), an autoimmune disease that predominantly affects women of reproductive age, is one such condition.Given the lack of research in Iran regarding the experiences of women with MS in their maternal role, a study was developed in three phases. The first phase involves interviewing pregnant women with MS and mothers with MS who have children under one-year-old to explore the meaning of the maternal role. In the second phase, utilizing the findings from the initial interviews and the experts' opinions, a support program will be created to assist women with MS during pregnancy and after giving birth, and in the last stage, this program will be evaluated by nominal group technique.

The Unmet Needs of Women with Maternal Near Miss Experience: A Qualitative Study.

Introduction: A maternal near-miss (MNM) case is defined as "a woman who nearly died but survived from life-threatening pregnancy or childbirth complication". This study was conducted on health care providers and near-miss mothers (NMMs) with the aim of discovering the unmet needs of Iranian NMM. Methods: In this qualitative study 37 participants of key informants, health providers, NMMs and their husbands were selected using purposive sampling. Semi-structured in-depth interviews were conducted for data collection until data saturation was achieved. Data were analyzed using Graneheim and Lundman conventional content analysis. Results: The analysis revealed the core category of "the need for comprehensive support". Eight categories included "psychological", "fertility", "information", "improvement the quality of care", "sociocultural", "financial", "breastfeeding" and "nutritional" needs emerging from 18 sub-categories, were formed from 2112 codes. Conclusion: Many of the real needs of NMM have been ignored. Maternal health policymakers should provide standard guidelines based on the needs discovered in this study to support the NMMs' unmet needs.

Exploring Health Providers' Perspective Regarding the Needs of Adolescent Mothers During Breastfeeding: A Qualitative Study.

Background: The prevalence of breastfeeding is less common among adolescent mothers than adult mothers. These mothers experience various issues during breastfeeding. The present study aimed to explore the normative needs of adolescent mothers during breastfeeding from health care providers' perspective. Methods: This qualitative content analysis study was conducted from October 2022 until June 2023. 14 health care providers who had worked in the field of breast milk were purposefully selected with maximum variation. Face-to-face semi-structured interviews were conducted and sampling continued until data saturation. Data analysis was performed using Graneheim and Lundman's method with MAXQDA software version 10. Results: The main concepts obtained from the data were classified into one theme entitled, "comprehensive support", and seven categories including "need to correct wrong traditional beliefs", "educational and counseling needs", "providing quality services", "need for psychological support", "need for protective laws", "financial needs", and "the need for social network support". Conclusion: Adolescent mothers in Iran have various needs during breastfeeding, and they require the assistance of their families, healthcare providers, and the government to fulfill them. Therefore, it is also recommended that policymakers in the health system should design policies to accommodate the requirements of this group of mothers. In addition to policy development in the health system, the infrastructure required for policy and law to be executed should be considered.

Explaining the experience of breastfeeding in women with gestational diabetes and designing and implementing an educational program based on planned behavior theory: a combined exploratory study protocol.

BACKGROUND: Gestational diabetes is a type of carbohydrate intolerance that is diagnosed for the first time during pregnancy. Researches have shown that gestational diabetes is associated with many negative prenatal and birth outcomes. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. Research findings indicate a decrease in breastfeeding in mothers with gestational diabetes/ or contradictory tissues regarding the factors affecting the breastfeeding behavior of mothers with gestational diabetes and a special program to promote breastfeeding for these mothers based on the social and cultural conditions of Iranian society. The present study aims to design an interventional program with a mixed qualitative study based on the theory of planned behavior (PBT) to prevent the decrease of breastfeeding in diabetic mothers. METHODS/DESIGN: A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The purpose of the first phase is to understand the experience of breastfeeding mothers who had gestational diabetes, which will be done using the directed content analysis method. The purposive sampling will be used on pregnant mothers with gestational diabetes 30-34 weeks and mothers with infants (up to 6 months) with a history of gestational diabetes. The second phase include designing and implementing an educational program based on the PBT: Education will be conducted based on the needs assessment of the qualitative phase, the opinions of the focus group, and the literature review, then the breastfeeding behavior will be measured using the survey tool of "breastfeeding drop". The third phase: Interventional quantitative phase: The sample size will be carried out by a pilot study, then a designed program as an educational intervention for teaching breastfeeding behavior based on the PBT for 30-34 weeks pregnant mothers with gestational diabetes will be implemented during 3-4 sessions and breastfeeding behavior will be evaluated after delivery. DISCUSSION: This is the first mixed-method study in Iran that led to implement an interventional program based on the theory of planned behavior. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. We hope that the result of this research will be a step in solving breastfeeding problems in mothers with gestational diabetes.

Gestational diabetes is a type of carbohydrate intolerance diagnosed for the first time during pregnancy. The rate of gestational diabetes has increased along with the increase in the prevalence of diabetes risk factors. It is associated with multiple prenatal and birth outcomes. Despite the incomparable benefits of breastfeeding providing health to gestational diabetes mothers, the rate of breastfeeding is low. This is the first study in Iran using a mixed method approach in 3 phases to implement an educational interventional program with a qualitative study directed by theory of planned behavior (TPB) to prevent the decrease of breastfeeding in mothers with gestational diabetes. The purpose of first phase of study (qualitative) is to understand women's experience of gestational diabetes, which will be done using the directed content analysis method. The purposive sampling will be used for pregnant mothers with gestational diabetes at 30­34 weeks and mothers with infants (up to 6 months). The second phase is designing and implementing an educational program based on the PBT: Educational aims and content will be prepared based on the need achieved in the qualitative phase, the opinions of the focus group with experts? Mothers? Whom? And the literature review, then the breastfeeding behavior will be measured using the survey tool "breastfeeding drop". The third phase includes: Interventional quantitative phase an educational program will be implemented for training breastfeeding behavior based on the theory of PBT for 30­34 weeks pregnant mothers with gestational diabetes. This program will be administered as an educational intervention during 3­4 sessions and breastfeeding behavior will be evaluated after delivery.

Designing, validation and evaluation of the expert system of "Healthy Menopause" and assessing its effect on the management of menopause symptoms: an exploratory mixed method study protocol.

BACKGROUND: Menopause is a period of women's life that has the especial physical, psychological and social challenges. So provision of an effective, practical and affordable way for meeting women's related needs is important. In addition, women should be able to incorporate such programs into their daily work. Considering the dearth of suitable services in this regard, this study will be conducted with the aim of designing, validating and evaluating the "Healthy Menopause" expert system on the management of menopausal symptoms. METHODS/DESIGN: A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase is a qualitative conventional content analysis study with purposes of exploring the women's experience of menopausal symptoms and extracting their needs, and collecting data about their expectations from a healthy menopause expert system.. The purposive sampling (In his phase data will be gathered through interviewing menopaused women aged 40 to 60 years old and other persons that have rich information in this regard and will be continued until data saturation. The second phase includes designing a healthy menopause expert system in this stage, the needs will be extracted from the qualitative findings along with a comprehensive literature review. The extracted needs will be again confirmed by the participants. Then, through a participatory approach (Participatory Design) using nominal group or Delphi technique the experts' opinion about the priority needs of menopaused women and related solutions will be explored based on the categories of identified needs. Such findings will be used to design a healthy menopause expert system at this stage. The third phase of study is a quantitative research in which the evaluation of the healthy menopause expert system will be done through a randomized controlled clinical trial with the aim of determining the effect of the healthy menopause expert system on the management of menopause symptoms by menopausal women themselves. DISCUSSION: This is the first study that uses a mixed method approach for designing, validating and evaluating of the expert system "Healthy Menopause". This study will fill the research gap in the field of improving menopausal symptoms and designing a healthy menopause expert system based on the needs of the large group of menopause women. We hope that by applying this expert system, the menopausal women be empowered to management and improving their health with an easy and affordable manner.

Menopause is a period of women's life that has the especial physical, psychological and social challenges. So provision of an effective, easy for use and affordable way for managing related problems and meeting related needs is important. Menopause is a period of women's life that has physical, psychological and social consequences. It is important to identify methods that are effective, practical and affordable. New technologies can increase women's ability to access educational information. This is the first study for designing, validating and evaluating of the expert system "Healthy Menopause". A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The conventional content analysis method will be used. The second phase: Designing a healthy menopause expert system: It is based on the codes of women's challenges from the first phase, along with conducting interviews and literature review. The participatory approach (Participatory Design) through nominal group or if needed, Delphi method based on the categories of needs and solutions by considering the opinions of the participants, available experts related to this issue will be listed. It should be used to design a healthy menopause expert system at this stage. The third phase (quantitative): The evaluation of the healthy menopause expert system will be a randomized clinical trial that determine the effect of the healthy menopause expert system on the management of menopause symptoms. In the present study an expert system (ES) will be designed that can be installed on mobile phones and computers. This tool is not only educational but also interactively helps to adapt to continuous changes, so by asking questions about menopause the system will respond as if an expert (midwife or gynecologist) is giving advice.

Pregnant women's experiences of well-being in high-risk pregnancy: A qualitative study.

BACKGROUND: Physical changes in high-risk pregnancy (HRP) can lead to changes in mood and social relationships and negative effects on women's well-being. Individuals in different sociocultural contexts have different perceptions of well-being. Yet, there is limited information about perceptions of well-being in HRP. This study aimed to explore the Iranian women's experiences of well-being in HRP. MATERIALS AND METHODS: This qualitative study was conducted in 2019-2020 through directed content analysis based on the conceptual framework of well-being in HRP. Participants were 26 women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran. Face-to-face semistructured interviews were held for data collection until data saturation. Data were analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed using the MAXQDA (v. 10) program. RESULTS: Well-being in HRP had seven attributes in the five main dimensions of physical, mental-emotional, social, marital, and spiritual well-being. The seven attributes of well-being in HRP were controlled physical conditions, controlled mood, emotions, and affections, perceived threat, self-efficacy, and competence for multiple role performance, maintained social relationships, meaning seeking and relationship with the Creator, and positive marital relationships. CONCLUSION: The present study provide an in-depth understanding about well-being in the Iranian women with HRP. It is a complex and multidimensional concept with physical, mental-emotional, social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to promote well-being among women with HRP and designed the guidelines to provide woman-centered care.

Investigating the Effect of Supportive Interventions on Initiation of Breastfeeding, Exclusive Breastfeeding, and Continuation of Breastfeeding in Adolescent Mothers: A Systematic Review and Meta-Analysis.

Introduction: The initiation of breastfeeding, exclusive breastfeeding, and its duration for 2 years in adolescent mothers is less than adult mothers. The purpose of this study is to determine the effect of supportive interventions on the initiation of breastfeeding, exclusive breastfeeding, and continuation of breastfeeding in adolescent mothers. Methods: Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, ProQuest, SID, Iranmedex, and Google Scholar were searched to find English and Persian clinical trial studies without time limit. The Cochrane checklist was used to check the bias of the articles. Data analysis was done using STATA version 11. I-squared index was used to check the heterogeneity, and funnel plot and Begg test were used to examine the publication bias. The combined odds ratio (OR) and random effects model were used to combine the studies and perform meta-analysis. Results: Of 492 articles, 11 articles were entered to the systematic review. Of 11 articles, three articles were entered to the meta-analysis. The supportive interventions included educational and counseling interventions, home visit, and peer support. The results of the present random effects meta-analysis model showed that the combined OR was 3.38 with 95% confidence interval (1.66-6.88, p = 0.001), thus that, breastfeeding initiation in the intervention group was higher than the control group. Conclusion: Supportive interventions such as educational and counseling interventions, home visits, and peer support are suitable strategies to promote breastfeeding in adolescent mothers. Therefore, it is suggested to integrate these strategies in prenatal and postpartum care of adolescent mothers.

High Risk-pregnant Women's Experiences of Risk Management: A Qualitative Study.

Background: Maternal and fetal morbidity and mortality depend on identifying of pregnancy risks and risk management. There is a dearth of information about the experiences of high-risk pregnant mothers in self-mitigation of the risk in the socio-cultural setting of Iran. This research was conducted to explore the risk management experiences of high-risk pregnant mothers. Methods: This Qualitative study was conducted in educational hospitals in Mashhad, Iran, from July 2018 to December 2020. The purposive sampling method was used to recruit the participants based on medical or obstetric high-risk conditions in pregnancy. Qualitative data were obtained from in-depth and semi-structured 29 interviews. Mothers' experiences of pregnancy in a risky condition were asked, and the interview continued until data saturation. Data were analyzed using the MAXQDA 10 software and the Elo and Kyngäs method. Results: Maternal experiences for risk management in pregnancy were formed by nine sub-categories and three categories: the excitement of emotion including: "feeling worry and despair", "gladness in the shadow of hope and optimism", "momentary shocking and excitement", and "inactivity and helplessness"; self-contemplation including: "active analysis of the ways of moderating the risk", "cognitive denial", and "ignoring the risk"; and witnessed action including: "problem-focused and rational actions", and "avoidance and inefficient engagements". Conclusion: Risk management experiences of pregnant women with high-risk pregnancies include a wide range of positive and negative feelings, effective and ineffective thoughts, and behaviors. Mutual collaboration between mothers and midwives/obstetricians by providing high-quality risk management counseling can lead to choosing effective risk management strategies.

Novel Memories of Motherhood: Childbirth Lived Experiences of Mothers with Coronavirus Disease 2019 (COVID-19).

Introduction: The critical coronavirus pandemic presents a global challenge with dimensions yet unknown, underscoring the essential need to comprehend the lived experiences, especially for vulnerable groups. This study delves into the childbirth experiences of mothers dealing with coronavirus disease 2019 (COVID-19). Methods: Employing hermeneutic phenomenology, this qualitative research was conducted at Mashhad University of Medical Sciences (Iran). Purposeful sampling involved 16 mothers with maximum variation. Unstructured telephone interviews collected data, analyzed using the Diekelman approach. Results: Unveiling the theme "Novel Memories of Motherhood," four central themes emerged: "The Missing Link in Quality Care," "Coronavirus Stigma," "A lonely mother in quarantine," and "Cascade of Psychological Trauma." Conclusion: COVID-19 acts as an intervening factor, distorting routine care and delivery programs. The focus for service providers attending to mothers in labor should extend beyond physical care, encompassing the elimination of coronavirus-related stigma and prioritizing psychological attention. This holistic approach is crucial for maintaining quality care standards.

The Role of Probiotics in the Treatment of Vulvovaginal Candidiasis: A Systematic Review and Meta-Analysis.

Background: Vulvovaginal candidiasis is one of the most common vaginal infections worldwide. We conducted this systematic review and meta-analysis to determine the effect of probiotics in the treatment of vulvovaginal candidiasis. Methods: A comprehensive search of databases including PubMed, Scopus, Cochrane, Scientific Information Database (SID), IranMedex, and Google Scholar search engine was performed. The search was conducted from inception to 1 October 2022, to identify published English or Persian language randomized control trials (RCTs) of women with vulvovaginal candidiasis who received probiotics as medical treatment. The quality of the included studies was assessed using the Oxford Center for Evidence Based Medicine checklist All statistical analyses were performed using Comprehensive Meta-analysis (CMA) version 2. Results: Six RCTs were included in this review. The results showed that treatment with probiotic was not different from placebo regarding the rate of positive culture (OR: 1.12; 95% CI: 0.390 to 3.26, P=0.825); treatment with probiotic was more effective compared to placebo regarding the rate of recurrence. (OR: 0.14; P= 0.01; 95 % CI: 0.028-0.7). Conclusion: Probiotics have a beneficial effect in the treatment of women with vulvovaginal candidiasis. Our results provide evidence for an alternative treatment modality for vaginal candidiasis using probiotics.

Development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index in Mashhad: a methodological study.

BACKGROUND: Assessment of well-being in high-risk pregnancy (HRP) is the key to achieve positive maternal and fetal outcomes. Although there are a wide range of instruments for well-being assessment, none of them is comprehensive for well-being assessment in HRP. The present study aimed at the development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index (HRPWBI). METHODS: This methodological study was conducted using the Waltz's four-step method. The dimensions of well-being in HRP were determined based on a conceptual model and the blueprint and the item pool of HRPWBI were developed. Then, the face and the content validity were assessed and item analysis was performed. Construct validity was also assessed through exploratory factor analysis with principal component analysis on the data obtained from 376 women with HRP in Mashhad, Iran. Finally, internal consistency, test-retest stability, sensitivity, and interpretability of HRPWBI were assessed. RESULTS: The scale- content validity index (SCVI) of HRPWBI was 0.91. In factor analysis, 33 items were loaded on seven factors which explained 53.77% of the total variance. Internal consistency, relative stability, absolute stability, sensitivity, and interpretability of HRPWBI were confirmed with a Cronbach's alpha of 0.84, a test-retest intraclass correlation coefficient of 0.97, a standard error of measurement of 0.92, a minimal detectable change of 8.09, and a minimal important change of 2.92, respectively. CONCLUSION: HRPWBI is a valid and reliable instrument for well-being assessment among women with HRP. It can be used to assess well-being and the effects of well-being improvement interventions on well-being among women with HRP.

High-risk pregnancy (HRP) is one of the world's most serious reproductive health issues. Assessing well-being in high-risk pregnancies is the key to achieving positive maternal and fetal outcomes. This study aims to develop, psychometrically test and validate the High-Risk Pregnancy Well-Being Index (HRPWBI). This study demonstrated that the (HRPWBI) is a valid and reliable tool for assessing the well-being of HRP women. It can evaluate the state of well-being in women with high-risk pregnancies, investigate the factors influencing the well-being of mothers with high-risk pregnancies, and examine the effects of interventions on improving well-being in women with HRP. To ensure that Policy maker, researchers and Clinicians in management of women with High-Risk Pregnancy incorporates measures to improve the well-being of this vulnerable group of women with high-risk pregnancies into its planning and policies.

High-risk pregnant women's experiences of the receiving prenatal care in COVID-19 pandemic: a qualitative study.

BACKGROUND: Women with high-risk pregnancies are among the most vulnerable groups that require additional precautionary measures against the spread of COVID-19 plus receiving prenatal care. Yet, there is limited information on the status of prenatal care in women with high-risk pregnancies. The purpose of this study was to explore the experiences of women with high-risk pregnancies who were receiving prenatal care during the COVID-19 pandemic. METHODS: The present qualitative study was conducted on mothers with high-risk pregnancies from September 2020 to March 2021. Purposeful sampling continued until achieving data saturation. Ghaem, Ommolbanin, and Imam Reza in Mashhad, Iran served as the research environment. Face-to-face and semi-structured interviews were effective data collection methods. Each interview lasted between 20 to 45 min (on average 30). The total number of participants was 31. Data analysis was carried out simultaneously with data collection using the qualitative content analysis method developed by Granheim and Landman (2004). RESULTS: Following the reduction and analysis of data from women in high-risk pregnancies, as well as their perceptions and experiences with health services during the COVID-19 pandemic, eight subcategories and three main categories were identified, including 1) "Negative psychology responses," 2) "Adoption behavior," and 3) "Adjustment of health services in mutual protection." Fear, anxiety, stress, feelings of loneliness, sadness, depression, guilt, doubt and conflict in receiving services were examples of negative psychological responses. The adaptive behaviors' category reflected the behaviors of women with high-risk pregnancies in the context of the COVID COVID-19 pandemic. The Adjustment of health services in mutual protection indicated that health workers took preventive and protective measures against COVID-19, which, in addition to protecting themselves and their clients against COVID-19, gave women a sense of security. CONCLUSION: Receiving prenatal care during the COVID-19 pandemic presents challenges for women with high-risk pregnancies, negatively impacting their psychological state and health-seeking behavior. Supportive and preventive care can ensure that women with high-risk pregnancies receive optimal prenatal care that focuses on COVID-19 prevention. We recommend implementing screening, psychological counseling, and education for women with high-risk pregnancies, as well as ensuring that they have access to women-centered health care services.

Women's interdependence after hysterectomy: a qualitative study based on Roy adaptation model.

BACKGROUND: Hysterectomy is a difficult process that some women encounter that can affect their interdependence, but its impact on women's Interdependence has received less attention. Therefore, this study aimed to explain women's Interdependence after hysterectomy. METHODS: This qualitative study was performed using a directed content analysis approach in Mashhad (Iran). Thirty women with a history of hysterectomy were included in the study by purposive sampling method. Data were collected from August 2018 to November 2019 using semi-structured interviews based on the interdependence mod of the Roy adaptation model until data saturation. Data analysis was performed using MAXQDA software and the deductive approach of Elo and Kingas (J Adv Nurs 62(1):107-115, 2008. https://doi.org/10.1111/j.1365-2648.2007.04569.x ). RESULTS: Data analysis led to the production of 537 initial codes from participants' experiences. By merging and categorizing them, the theme of "increasing interdependence" emerged, which consists of 2 categories: "Evolution independence and interaction with important people in life" and "Reinforced support system", that include six subcategories. CONCLUSION: After hysterectomy, women not only feel a strong need for support from family members, especially their husbands, they are also seeking support from health care providers and their colleagues. Before the hysterectomy, it is recommended that family members be consulted to ensure the emotional support and care of women after the hysterectomy. It can help the adaptation to hysterectomy.

Death-stricken survivor mother: the lived experience of near miss mothers.

BACKGROUND: A Near Miss Mother (NMM) who survives life-threatening conditions, experiences intense physical, emotional, and psychological consequences following the maternal near-miss (MNM) events. The aim of this study was therefore to explore indepth understanding meaning of NMM everyday lived experiences on the social and cultural background of Iran. METHODS: This qualitative study utilized a hermeneutic phenomenology procedure. The study was conducted in hospitals affiliated with the Educational, Research and Treatment Centerwhich usually handle the NMMs. The sampling was purposeful with a maximum variation of eleven NMMs. Datawere collected using unstructured face-to-face interviews, and thetranscribed data were analyzed using Diekelmann, Allen, and Tanner's seven-stage thematic analysis approach. RESULTS: "Death-stricken survivor mother" was the central emerged theme, and three extracted sub-themes included: "Distorted psyche on a journey to death", "physical destruction due to an ominous event ", and the "vicissitudinous life after reviving ". These sub-themes, in turn, involved 12 sub-themes that emerged from 38 common meanings and 1200 codes. CONCLUSIONS: Findings demonstrate that the living conditions of NMMs are mixed in all aspects of the MNM event. They need a supportive program that includes additional follow-up visits, psychological support from the time of hospitalization until long-time after discharge, alleviation of social, sexual, and financial worries to return them to the normal life, as well as psychosocial rehabilitation to increase their life quality. Furthermore, post-discharge care in NMMs should be done actively and directly at their homes.

A maternal near miss (MNM) is a life-threatening condition experienced by a mother with organ failure due to severe maternal morbidity. Near miss mother (NMM) experiences adverse outcome such as physical, emotional, and psychological consequences after near miss event. Understanding the meaning of these mothers' lived experience and listening to their voices will help in reducing the burden of complications and will be effective in rehabilitating the disability created in their life. "Death-stricken survivor mother" was the central emerged theme resulting from the study of phenomenology. The main body of this theme reflects the severe physical, psychological burden and vicissitudes life. Server maternal morbidity due pregnancy and childbirth, have made NMM mother's life very different from those of normal mothers. The living conditions of these mothers are mixed in all aspects of the MNM event. Long-term physical and psychological damages they have endured, should be on the agenda of women's health policy makers to support them for years after discharge with integrated care.

A comparative study of the effect of face-to-face counseling and telephone counseling on attitudes toward infertility in infertile couples.

BACKGROUND: Couples' attitudes toward infertility are related to different dimensions of infertility. Counseling can change attitudes toward infertility in infertile couples. Therefore, this study was conducted to determine and compare the effect of face-to-face counseling and telephone counseling on infertility attitudes in infertile couples. MATERIALS AND METHODS: This two-group intervention study was performed on 34 infertile couples who were randomly assigned to face-to-face and telephone counseling groups. The couple attended counseling sessions as scheduled by the researcher. An Infertility Attitude Questionnaire was completed by all participants at the beginning and end of the study. Data were analyzed using SPSS software version 16. RESULTS: The results of independent t test showed that after the intervention, the mean score of attitude toward infertility in the face-to-face counseling group was significantly higher than the telephone counseling group. Based on paired t test, the mean score of infertility attitude in the face-to-face counseling group was significantly increased two weeks after the intervention compared to before. The mean score of infertility attitude in the telephone counseling group was significantly increased two weeks after the intervention compared to before. According to the results of independent t test, the attitude score toward infertility was not statistically significant between the two groups. CONCLUSION: The results of the present study showed that with counseling, the mean score of infertility attitude in infertile couples in both groups had increased. In other words, counseling can change attitudes toward infertility in infertile people.

Mothering sweetness mixed with the bitterness of death: the lived mothering experience of near-miss mothers.

PURPOSE: Maternal near miss (MNM) refers to women who survive death as a result of life-threatening obstetric complications or organ system dysfunction during pregnancy, childbirth or postpartum. The aim of the present study was to gain an understanding of mothering experiences in survivors 'mothers due maternal near miss event. MATERIALS AND METHODS: Heideggerian hermeneutic phenomenology guided this qualitative study. The study was conducted 1 June and 30 December 2019. The sampling was purposeful with maximum variation of 11 near miss mother that used unstructured face-to-face interview for data collection. Data analyzed using Diekelmann, Allen, and Tanner seven stage thematic analysis approach. FINDINGS: Emergent theme was "mothering sweetness mixed with the bitterness of death." The two themes constituting the essence was: "An Angel with Broken Wings" and "Mothering in the Shadow of Death." The subthemes comprised five sub-sub themes which emerged from over 850 meaning units. Data were analyzed using MAXQDA10 software. CONCLUSION: Maternal health providers need to know that it is not enough only to focus on saving the mother's physical life. While strengthening the role of mothering is essential element to support near-miss mothers who have experienced difficult physical and psychological conditions. The "beyond numbers" concept, implies that it is not enough only to focus on saving the mother's physical life. Removing barriers in order to achieve to early mothering, can have a significant impact on reducing the psychological burden of MNM events.

The relationship between global gender equality with maternal and neonatal health indicators: an ecological study.

PURPOSE: Achieving the millennium development goals (MDGs) and sustainable development goals (SDGs) including gender equality, reducing maternal, neonatal, and under 5 mortality rates are still considered a major global challenge. This study was performed with the aim of investigating the relationship between global gender equality and maternal as well as neonatal, and under 5 children health indicators. MATERIALS AND METHODS: The present study is an ecological study performed through credible secondary data published in 2017 for each country. Then, the Gender Equality Index along with its four areas, maternal mortality, neonatal mortality, and under 5 mortality rates were extracted. Data analysis was performed by SPSS 24 via descriptive-analytical statistics and linear regression. RESULTS: There was a significant and direct correlation between all of the three variables of maternal mortality, neonatal, as well as under 5 mortality and Gender Equality Index. Correlation analysis between the above-mentioned indicators and the areas of Gender Equality Index showed that there is no significant correlation between the "economic opportunities and participation" index and none of the maternal, neonatal, and under 5 mortality indicators. The "educational attainment" index had an inverse significant correlation with the above-mentioned variables. The "survival and health" index had only an inverse significant correlation with neonatal mortality, and "political empowerment" had such a correlation with neonatal and under 5 mortality rates. CONCLUSIONS: Panning and policymaking for reducing gender equality barriers should be among the top priorities of primary healthcare in order to achieve maternal, neonatal, and under 5 health universally.

Improving the quality of care in pregnancy and childbirth with coronavirus (COVID-19): a systematic review.

In the context of serious coronavirus epidemic, it is critical that pregnant women not be ignored potentially life-saving interventions. So, this study was designed to improve the quality of care by health providers through what they need to know about coronavirus during pregnancy and childbirth. We conducted a systematic review of electronic databases was performed for published in English, before 25 March 2020. Finally, 29 papers which had covered the topic more appropriately were included in the study. The results of the systematic review of the existing literature are presented in the following nine sections: Symptoms of the COVID-19 in pregnancy, Pregnancy management, Delivery Management, Mode of delivery, Recommendations for health care provider in delivery, Neonatal outcomes, Neonatal care, Vertical Transmission, Breastfeeding. In conclusion, improving quality of care in maternal health, as well as educating, training, and supporting healthcare providers in infection management to be prioritized. Sharing data can help to countries that to prevent maternal and neonatal morbidity associated with the COVID-19.