A clinical guideline for the Iranian women and newborns in the postpartum period.

BACKGROUND: The postpartum is a vital period for women, newborns, spouses, parents, caregivers, and families. Regarding the importance of postpartum care and the lack of comprehensive and up-to-date clinical guidelines in the country of Iran, the postpartum clinical guidelines have been adapted. METHODS: Cultural adaptation was conducted in three stages. In the first stage, the adaptation team was formed and the process was approved. During the second stage, a systematic literature review was conducted using international databases to identify English-language clinical guidelines published within the last 10 years. Out of 17 guidelines and documents initially selected, 5 guidelines meeting the inclusion and exclusion criteria and published within the last 5 years were chosen following a thorough review by the search team. In the secondary selection, the guidelines were investigated by two subject-matter experts based on AGREE II Checklist, and regarding the high evaluation score obtained by the WHO Recommendations on Postnatal Care of the Mother and Newborn (2022), and the National Institute for Health and Care Excellence (NICE,2021) guideline for postnatal care were selected for cultural adaptation. In the third stage, the opinions of experts from all over the country were collected and scored using the Delphi method, and a final guideline was formulated. RESULTS: The adapted postpartum clinical guideline has offered 56 recommendations. The recommendations are categorized into four major themes including mother care, newborn care, health system and health promotion interventions and post caesarean care. CONCLUSION: Applying evidence-based recommendations for the care of mothers and babies in the postpartum period will enhance the health system, promote the provision of care after vaginal and caesarean births, and ensure a positive postnatal experience for mothers, fathers, babies, and families.

Adaptation and implementation of clinical guidelines on maternal and newborn postnatal care in Iran: study protocol.

BACKGROUND: According to World Health Organization (WHO), the postnatal care provision aims to provide care and treatment with the highest quality and the least intervention to obtain the best health and well-being for the family. The present study aims to adapt international guidelines for the clinical recommendations for the postpartum period and implement and determine its effectiveness. METHODS/DESIGN: This study will be done in two phases. In the first phase, international clinical guidelines for mother and newborn postnatal care will be adapted. The second phase is a randomized controlled trial in which the adapted guideline recommendations will be implemented, and maternal and neonatal outcomes will be measured. The ADAPTE method for adaptation of clinical guidelines, is usedg in the first phase. A systematic review was conducted in the databases and clinical guidelines related to postpartum care were extracted according to the inclusion criteria. The quality of clinical guidelines was evaluated using the AGREE-II tool. The WHO clinical guideline obtained the highest evaluation score and was chosen as the main guideline, and the NICE clinical guideline, with a second higher evaluation score, was also used to fill some gaps in the WHO guideline. Based on the pre-determined questions, recommendations will be sent to the relevant experts and stakeholders for their evaluation. After the external evaluation and the finalization of the recommendations, the postpartum clinical guideline will be compiled and used in the second phase of the study. In the second phase, 272 women in the immediate postnatal stage of the maternity and postpartum ward of Taleghani and AL-Zahra Hospitals in Tabriz will be assigned into the intervention (receiving care based on adapted guidline recommendations) and control (receiving routine hospital care) groups uing individual stratified block randomization. At 6 weeks after birth, we will complete the Edinburgh postnatal depression scale, postpartum specific anxiety scale and Barkin index of maternal functioning (to assess the primary outcomes), as well as a maternal health problems checklist, infant care behavior, and violence assessment questionnaires (to asses the seconadary outcomes). Further, the maternal health problems checklist and the Edinburgh postnatal depression scale will be completed in the second week after birth. The data will be analyzed using an independent t-test and ANCOVA. DISCUSSION: It is expected that the implementation of evidence-based clinical guidelines improves maternal and neonatal outcomes and experience of the postpartum period. The positive experience can also help to achieve Iran's population policies and the need to increase childbearing in the country. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N76; Date of registration: 27/1/2023. URL: https://en.irct.ir/user/trial/66874/view ; Date of first registration: 27/3/2023.

The postpartum period, starting immediately after childbirth up to the first six weeks (42 days), is a significant and critical period in the lives of mothers and newborns, spouses, caregivers, and families. Maternal and newborn deaths and complications are high during the postpartum period. Postpartum care with high quality could reduce maternal and newborn deaths and complications, and makes the mother have a positive childbirth experience and a favourable attitude toward her next birth. World Health Organization (WHO) recommend providing medical care and treatment with the highest quality and the least intervention to obtain the best health and well-being conditions for the family. The present study aims to localize and use the international recommendations for the postpartum period in Iran. This study will be done in two phases. In the first phase, the international recommendations for mother and newborn care and postnatal well-being will be adapted according to our country's resources and conditions. In the second phase, the recommendations of adapted guideline will be implemented on 272 mothers and newborn in two groups in the maternity and postpartum ward of Taleghani and AL-zahra Hospitals in Tabriz, and we compare the result of using these recommendations and routine care on mothers' and newborns' well-being. In clinical guideline recommendations group, we will educate mothers, fathers and families and will share with them adapted recommendations, up to 6 weeks after birth and we will support them via the network. During the postpartum period we will assess mental and physical health problems of the mothers; counsel about breastfeeding, baby care, family planning, nutrition, activity, pain killer, bonding and emotional attachment, and prevention of postpartum depression; and any questions will be answered.

The effect of a coping program on mothers' grief following perinatal deaths.

BACKGROUND: Mother-child attachment is formed from early stages of pregnancy and peaks in the second trimester and continues until after childbirth. The fetal or neonatal death as a tragic event could lead to the grief experience among parents, especially mothers. The present study aimed to determine the effect of a coping program on mothers' grief following perinatal deaths. MATERIALS AND METHODS: This trial study was performed on 56 women with the experience of perinatal death during the last 1-3 months with a score of Perinatal Grief Scale (PGS) ≥91, who were referred to the health centers of Tabriz, Iran, from September 2020 to June 2021. Participants were randomly assigned into the intervention and control groups through stratified blocking on the basis of the stillbirth and neonatal death using Random Allocation Software with a block size of 4 and 6 with a ratio of 1:1. The intervention group received a coping program individually during three sessions, once a week for 45-60 min. Data collection tools included the demographic and obstetric characteristic questionnaire and PGS. The data were analyzed using SPSS24. The groups were compared through t-test, and ANCOVA after adjusting the effect of baseline score. RESULTS: Prior to coping program, the mean standard deviation of the grief total score was 108.32 (14.31) in the intervention group and 107.92 (6.65) in the control group (P = 0.89). After coping program, the mean of the grief total score was 82.28 (16.72) in the intervention group and 101.05 (12.78) in the control group. After adjusting the effect of baseline score and stratified factors, the mean of the grief total score in the intervention group was significantly lower than that in the control group [Adjusted mean difference (AMD): -18.77, 95% confidence interval: -26.79 to - 10.75, P ≤ 0.001]. CONCLUSION: Conducting a coping program during 1-3 months after experiencing perinatal deaths is effective in reducing the mothers' grief reactions. It is recommended to evaluate the effectiveness of the same intervention after perinatal deaths for both parents with a longer follow-up period in further studies.

Effect of cup, syringe, and finger feeding on time of oral feeding of preterm neonate's: a randomized controlled clinical trial.

BACKGROUND: The oral nutrition is big challenge for preterm neonates. Since the best oral feeding method for preterm neonates is not yet known, the present study aimed to evaluate the effect of cup, syringe, and finger feeding methods on reaching the time of full oral feeding and weight gain among preterm neonates. METHOD: This randomized clinical trial study was conducted on 99 preterm neonate's, born at 30-34 weeks gestation, admitted to the neonatal intensive care unit (NICU) of Al-Zahra and Taleghani Therapeutic-Educational Centers in Tabriz, Iran. Subjects were assigned into finger feeding (n = 33), cup feeding (n = 33), and syringe feeding (n = 33) groups in the allocation ratio of 1:1:1 using block randomization with a block size 6 and 9. They were studied in terms of reaching the time of full oral feeding and weight gain. The data were analyzed using SPSS/version21 software, and ANOVA, chi-square, and ANCOVA tests. RESULTS: There was no significant difference in the mean score of reaching the time of full oral feeding among cup, finger, and syringe feeding groups (p = 0.652). The mean score of daily weight gain, oxygen saturation (SaO2), and heart rate after feeding was not significantly different among the three groups (p > 0.05). The effect of confounding variables, including birth weight and age, arterial oxygen saturation, and heart rate before feeding, was controlled. CONCLUSION: Based on the results, one of the cup, finger, and syringe feeding methods can be applied in the NICU, considering the staff's proficiency in feeding neonates. Trial registration IRCT20150424021917N11.