Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care.

INTRODUCTION: The aim of this study was to compare maternal and neonatal outcomes in the care provided by Doula, trained lay companion, and routine midwifery care in the labor and obstetric units. In this study, only results related to maternal outcomes were presented. METHOD: This is a quasi-experimental study, which was conducted on 150 women with low-risk pregnancies who had been selected for vaginal birth at private clinics and public hospitals of Arak, Iran. Participants were divided into three groups, two intervention groups, doula and trained lay companion, and one control group, midwife's routine care. The intervention groups, in addition to receiving routine care from the labor and maternity units, also received support and training by doula or a trained lay companion, but 50 the control group received only routine midwifery care. In the control group and the trained companion, the samples were taken from 10 clinics of different parts of the city by random sampling method using the SIB center system. Then, among selected numbers, we randomly selected samples for each group. But in Doula group, because of limited number of samples, convenience sampling was used and all women enrolled in doula care were included in the study until the number reached 50. In each group, outcomes such as the duration of active phase and second stage of labor, as well as the severity of pain, anxiety and maternal satisfaction with birth were measured and compared with other groups. Data were collected by a researcher-made checklist, the Spielberger's State-Trait Anxiety Inventory (STAI), the Pain Visual Assessment Scale (VAS), and the Hollins Martin's Birth Satisfaction Scale-Revised (BSS-R). Data were analyzed by SPSS-22 statistical software using Kruskal Wallis, Chi-Square, ANOVA and Fisher's exact tests. FINDINGS: Based on the results, the mean duration of active phase between three groups was 234.68 ± 118.74, 256.66 ± 108.75 and 279 ± 94.37 min, respectively (p = 0.022). Also, the mean duration of second stage in three groups was 10 ± 5.61, 10.35 ± 5.1 and 22.30 ± 75.57 min, respectively (p < 0.001). The difference between mean pain scores in the first, second, third, fourth and fifth hours was not statistically significant. The average difference in anxiety score in the two stages of labor was higher in the lay companion group, and this difference was statistically significant (p < 0.001); however, the level of satisfaction in doula group was higher compared to the lay companion and control groups (p < 0.00 1). CONCLUSION: According to present study, doula care has a greater effect on reducing the duration of labor than other care models. Based on the study, there was no statistically significant difference between the three groups in terms of variables such as the severity of labor pain. However, the level of anxiety of pregnant mothers in the group supported by lay companion was lower than the other two groups, which indicates the positive effect of mothers' training on increasing maternal comfort and satisfaction. It is suggested that further research investigate the severity of labor pain in groups supported by different care models and also we recommend the use of lay companion' support during childbearing of mothers who could not afford doula. TRAIL REGISTRATION: This article has been registered in Iran's Clinical Trial Center with the code: IRCT20230620058548N1. 2023/08/29.

Reproductive Health Concerns of Women With High Risk Sexual Behaviors.

INTRODUCTION: Expansion of reproductive health services and addressing its different aspects in national and international levels is an important step towards ensuring family and public health. Female sex workers are a vulnerable population that are exposed to high risk sexual behaviors and increased incidence of co-morbid health problems. This study aims to identify the concerns of women with high risk sexual behaviors. Clarifying different aspects of reproductive health and its problems in female sex workers can assist relevant authorities to plan and intervene on reproductive health and to provide more effective solutions on this issue. METHODS: A qualitative study was conducted using a conventional content analysis approach. Snowball sampling was performed in 20 volunteer women with high risk sexual behaviors through in-depth semi-structured interviews conducted in drop-in centers, triangle centers, etc. The data were analyzed through conventional content analysis using the MAXQDA software. RESULTS: Five main categories and 13 subcategories emerged during the interviews. The main categories included violence, fear, and lack of knowledge, stigma, and psychological problems. Women with high risk sexual behaviors have several reproductive health concerns, including unwanted pregnancy, abortion, STIs (Sexually transmitted infections), HIV, etc. In addition, different types of violence and threats against women, intimidation, objectification, stigma, unresponsiveness of counselling centers, patriarchal culture, gender inequality, etc. were observed in these women. CONCLUSION: The study revealed that women in this study experienced deep problems of reproductive health and little attention is paid to them by authorities. Proper planning and appropriate solutions should be provided to solve the problems of these women and the society.

Concerns of Infertile Women Candidates for Egg Donation: A Qualitative Study.

Objective: Women with premature ovarian insufficiency, menopause, gonadal dysgenesis, and genetic disorders as well as those with a history of recurrent in vitro fertilization failure may benefit from the assisted fertility techniques. These women experience concerns that directly affect their married life especially in egg donation treatment. This study was conducted to investigate the reproductive health concerns of infertile women who were candidates for egg donation. Materials and methods: This qualitative content analysis was conducted in 17 infertile women who were referred to Imam Khomeini Hospital Infertility Clinic from July 2018 to March 2019. The participants were selected through purposeful sampling. Data were collected through individual in-depth semi-structured interviews. A conventional qualitative content analysis approach was adopted for data analysis using the MAXQDA12 software. Results: The results of data analysis showed five themes, including threatened married life, lack of supportive situation, religious beliefs, psychosocial damage, and damaged feminine identity. Conclusion: Infertility is usually accompanied by a great psychological sadness referred to as "stress of infertility". Assisted reproductive techniques (ART) are also a source of stress for patients; therefore, it has a significant impact on the marital relationship and mental health of infertile women. Hence, there is a need for psychological support from the treatment team to reduce woman reproductive health concerns.

Quality of life (QoL) and help-seeking in postmenopausal women with urinary incontinence (UI): A population based study.

OBJECTIVE: UI is a common condition among women. UI adversely impacts upon QoL and participation in everyday activities. The aim of this study was to determine the relationship of QoL and help-seeking in postmenopausal women with UI. DESIGN: This cross-sectional correlation study took place from March to May 2012; the subjects were selected by multi stage sampling method from various zones of Rasht City (North of Iran). The data were collected using personal data form, Questionnaire for Urinary Incontinence Diagnose (QUID), Incontinence Severity Index (ISI) and Incontinence QoL questionnaire (I-QoL), data were analyzed by SPSS at the significant level of P<0.05 and then were compared by parametric and non-parametric tests. RESULT: Three hundred and thirteen menopause women aged 45-60 years (mean 52.9) were recruited in the study. Mean QoL score was 46.18 ± 19.91. Only 27.3% of subjects seek care for UI. There was no significant correlation between the QoL and help-seeking. CONCLUSION: According to the findings although QoL was impaired in women with UI, their help-seeking was low. Most of them did not consider UI an important problem; health professionals should educate patients and aware patients of available treatments.

Effect of educational software on self-efficacy of pregnant women to cope with labor: a randomized controlled trial.

AIM: The aim of this study was to determine the effect of educational software on self-efficacy of Iranian pregnant women to cope with labor. METHODS: This study was a randomized controlled trial which was carried out on 150 Iranian nulliparous pregnant women randomly assigned to two groups of 75 women each. The control group routinely did not receive any kind of childbirth education and the intervention group only received the childbirth educational software for 6-8 weeks. In order to determine self-efficacy, the Childbirth Self Efficacy Questionnaire (CBSEI) was used which measures the outcome expectancy and the self-efficacy expectancy of the first and second stages of labor separately. This questionnaire was completed at 28-32-week gestation as a pre-test and at 36-38 weeks as a post-test by the participants. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests. RESULTS: After the intervention, the median and mean of CBSEI scores for the intervention and the control groups were 607, 604/20 ± 16/630 and 394, 392/51 ± 16/758, respectively. There was a statistical difference between the two groups (p = 0.001). Also, statistically significant differences existed in the median of outcome expectancy and self-efficacy expectancy after intervention in both stages of labor between the two groups (p = 0.001). CONCLUSIONS: The educational software program significantly increased self-efficacy of Iranian pregnant women to cope with labor. Despite lack of educational childbirth classes in Iran, the use of this method is recommended. However, to find whether this technique can be substituted for the educational classes, further studies are needed.

Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor.

PURPOSE: To investigate the effects of massage and presenting an attendant on pain, anxiety and satisfaction during labor to clarify some aspects of using an alternative complementary strategy. METHODS: 120 primiparous women with term pregnancy were divided into massage, attendant and control groups randomly. Massage group received firm and rhythmic massage during labor in three phases. After 30 min massage at each stage, pain, anxiety and satisfaction levels were evaluated. Self-reported present pain intensity scale was used to measure the labor pain. Anxiety and satisfaction were measured with the standard visual analog scale. RESULTS: Massage group had lower pain state in second and third phases (p < 0.05) in comparison with attendant group but reversely, the level of anxiety was lower in attendant group in second and third phases (p < 0.05) and satisfaction was higher in massage group in all four phases (p < 0.001). The massage group had lower pain and anxiety state in three phases in comparison with control group (p < 0.05). Data analysis of satisfaction level showed higher values in four phases in massage group compared with control (p < 0.001) and comparison of attendant and control groups showed higher satisfaction in attendant group in phases 2, 3 and 4 as well (p < 0.001). Duration of active phase was lower in massage group (p < 0.001). CONCLUSIONS: Findings suggest that massage is an effective alternative intervention, decreasing pain and anxiety during labor and increasing the level of satisfaction. Also, the supportive role of presenting an attendant can positively influence the level of anxiety and satisfaction.