The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial.

INTRODUCTION: Childbirth may be associated with psychological, social, and emotional effects and provide the background for women's health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression. MATERIALS AND METHOD: This randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh's postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention. RESULTS: The mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01). TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022. CONCLUSION: The study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.

The effect of in-home supportive counseling on maternal functioning and self-efficacy following cesarean section among primiparous women.

BACKGROUND: Women require follow-up care and ongoing counseling after childbirth. The present study aimed to evaluate the effect of in-home supportive counseling on the maternal functioning and self-efficacy after CS among primiparous women. MATERIALS AND METHODS: This randomized controlled clinical trial was performed on 60 primiparous women aged 18-35 years following CS in Ardabil, Iran from April to November 2021. After convenience sampling, participants were randomly assigned into the intervention and control groups with a ratio of 1:1 by block randomization using Random Allocation Software with block sizes of 4 and 6. The intervention group received in-home supportive counseling during three sessions on days 3, 7, and one month after birth. The control group received only routine postpartum care. The data were collected using the demographic and obstetric characteristics, maternal self-efficacy questionnaire, and Barkin index of maternal functioning, completed by both groups 10-15 days, two, and four months after birth. Independent t-test and RMANOVA were used to analyze the data. RESULTS: The mean score of maternal functioning in the intervention group was significantly higher than that of the control group 10-15 days, 2 and 4 months after birth (AMD: 28.51, 95% CI: 24.91 to 32.10, P < 0.001). There was no significant difference in the mean (SD) score of maternal self-efficacy between the two groups 10-15 days after birth. However, this difference was statistically significant 2 and 4 months after birth and after adjusting the time effect (AMD: 10.56, 95% CI: 9.46 to 11.67, P < 0.001). CONCLUSION: In-home supportive counseling can be effective in improving maternal functioning and maternal self-efficacy after CS. Acquiring functional skills increases mothers' self-confidence and self-efficacy in caring for the newborn.

The effect of cognitive-behavioral therapy and haptonomy on fear of childbirth in primigravida women: a randomized clinical trial.

BACKGROUND: Considering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS), the present study aimed at evaluating the effect of Cognitive-Behavioral Therapy (CBT) and haptonomy on the FOC (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women. METHODS: This randomized clinical trial was conducted on 99 primigravida women in Tabriz, Iran 2022. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n = 33) received eight group sessions of CBT from 24 to 28 weeks of gestation and the other intervention group (n = 33) received haptonomy during seven sessions once a week. The control group (n = 33) received routine prenatal care. The Wijma questionnaire was completed by the participants before the intervention, after the intervention at 35-37 weeks of gestation, and after birth. The intended birth method was investigated before and after the intervention at 35-37 weeks of gestation. The final birth method and the reasons for CS were recorded based on the mother's medical profile. The one-way ANOVA was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. Further, chi-square test was applied to compare the intended and final birth method. RESULTS: The mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24-28 weeks of gestation to 46.50 (18.28) at 35-37 weeks and 48.78 (20.64) after birth (P < 0.001). The means (SDs) of FOC in the haptonomy group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively (P < 0.001). The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P = 0.878). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P = 0.278), and final birth method (P = 0.107). CONCLUSION: The findings of the present study revealed that both CBT and haptonomy interventions reduce FOC. Although the desire for vaginal birth and final vaginal birth in the haptonomy group was more than that in the other two groups, there was no statistically significant difference among the three groups. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20170506033834N9. Date of registration: 02.01.2022. URL: http://en.irct.ir .

Woman-centered care and associated factors among midwives working in urban health centers and public and private hospitals in Tabriz, Iran: a cross-sectional study.

BACKGROUND: Woman-centered care (WCC) is the cornerstone of the midwifery profession. However, no study has been conducted on WCC provided by Iranian midwives and its associated factors. Thus, this study aimed to determine WCC and factors associated with midwives' WCC for midwives working in urban health centers and public and private hospitals in Tabriz, Iran. METHODS: This cross-sectional study was the first part (i.e., the quantitative phase) of a sequential explanatory mixed-method study conducted on 575 midwives working in urban health centers and public and private hospitals in Tabriz-Iran from November 2022 to January 2023. The required data was collected by distributing a socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). To determine the factors associated with WCC, an independent t-test or one-way analysis of variance (ANOVA) was used in bivariate analysis, and a general linear model (GLM) was employed in multivariate analysis to control possible confounding variables. RESULTS: The statistical population consisted of 575 midwives, with a response rate of 88.2%. According to the GLM, the total mean WCCS-MSR score of single [ß (95% CI) 23.02 (7.94 to 38.10)] and married [ß (95% CI) 21.28 (6.83 to 35.72)] midwives was significantly higher than that of divorced midwives after adjusting their demographic and job characteristics. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income [ß (95% CI) 8.94 (0.12 to 17.77). In addition, the total mean WCCS-MSR score of midwives with < 5 years of work experience [ß (95% CI) - 7.87 (- 14.79 to - 0.94)], and midwives with official-experimental employment status [ß (95% CI) - 17.99 (- 30.95 to - 5.02)], was significantly lower than those with more than 5 years of work experience and contractual employment status. CONCLUSIONS: The findings indicate that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. Focusing only on the midwifery community is insufficient to ensure the improved quality of WCC. However, arrangements should be made at three levels, including policy-makers, managers, and health care provider (midwives).

As the cornerstone of the midwifery profession, WCC represents a universal, integrated, and synonymous concept with practice, which implies focusing on women as individuals. This cross-sectional study determined WCC and its associated factors of midwives working in urban health centers and public and private hospitals in Tabriz, Iran. A sample size of 575 midwives was used to determine the factors associated with WCC. The required data was collected by distributing a socio-demographic and job characteristics questionnaire and woman-centered care scale-midwife self-report (WCCS-MSR). A generalized linear model (GLM) was used to determine the factors associated with WCC. Midwives obtained the highest total mean score in the Works in Partnership with the Woman (WP-W) subscale and the lowest total mean score in the Ensures Midwifery Philosophy Underpins Practice within the Context of the Maternity Service (EMPUP-MS) subscale in the obtainable scores, which ranged from 0 to 100. Our study found that the total mean WCCS-MSR score of single and married midwives was significantly higher than that of divorced midwives. Also, the total mean WCCS-MSR score of midwives with sufficient income was significantly higher than those with insufficient income. In addition, the total mean WCCS-MSR score of midwives with < 5 years of work experience, and midwives with official-experimental employment status, was significantly lower than those with more than 5 years of work experience and contractual employment status. The findings indicated that marital status, level of income, years of practice, and employment status were significantly related to WCC provided by midwives. Therefore, to improve the quality of WCC, identifying the mentioned factors will help policy-makers to consider facilitating measures, providing practical solutions, and designing future interventions.

The Effect of Psychological Interventions on the Anxiety and Breastfeeding Self-Efficacy: A Systematic Review and Meta-Analysis.

Background: Maternal anxiety has been accompanied by many unfavorable effects on breastfeeding in the postpartum period. We aimed to provide scientific evidence in identifying effective interventions for anxiety and breastfeeding self-efficacy (BSE) in a systematic review and meta-analysis. Methods: All published studies with inclusion criteria by 2022 were searched in Embase, Cochrane library, Web of Sciences, Google Scholar, PubMed, Scopus, SID and Magiran. The literature search was performed using PRISMA instructions. Further, 20 eligible interventional studies (RCT and pre-posttest) and one case study were included in this systematic review and meta-analysis. Publication bias was checked with Eggers test and funnel plot methods. The collected data were analyzed using stata version16. Results: It is not possible to provide an explicit and accurate conclusion about the effective intervention method in reducing anxiety and increasing BSE among lactating women during the covid19 pandemic. The results indicated a significant increase in BSE among lactating women after educational and psychological interventions (4.20, 95% CI: 3.61 to 4.80, I2 = 26.38%). Conclusion: It is recommended to conduct further studies with a strong methodology and based on intervention methods during the postpartum period, especially in the first month of birth to reduce the symptoms of stress and anxiety in the mother, establish better mother-child attachment, and improve BSE and maternal performance during the Covid-19 pandemic.

The Effect of Decision Aid on Satisfaction With Decision and Anxiety Among Women With Abnormal Cervical Screening Results.

BACKGROUND: Most women in the face of stressful situations such as risk of a cancer diagnosis (abnormal Papanicolaou smear results) need guidance to choose the appropriate method to follow the diagnosis process, but few studies have identified appropriate interventions to support these women. OBJECTIVE: To determine the effect of decision aid on anxiety and satisfaction with decisions (SWD) regarding the type of follow-up method after receiving an abnormal Papanicolaou smear result. METHODS: This interventional study was conducted on women referred to the oncology clinic in Tabriz, Iran. Women were assigned to the intervention (n = 27) and control groups (n = 27) in a ratio of 1:1 using blocked randomization. The intervention group received a decision aid booklet. Participants in both groups completed questionnaires assessing demographic and obstetric characteristics, anxiety, SWD, and shared decision-making before and after the intervention. RESULTS: The mean score for SWD in the intervention group was significantly higher than that in the control group after the intervention (median, 6.43 with 95% confidence interval of 3.11-7.76; P = .03). There was no significant difference between groups in the mean score of anxiety after intervention (median, 1.14; 95% confidence interval, -0.5 to 2.70; P = .19). CONCLUSION: A decision aid can increase SWD among women with abnormal results in their cervical cancer screening. IMPLICATIONS FOR PRACTICE: It is recommended that healthcare providers use decision aid tools to support and guide patients.

Evaluation of woman-centred care status by Iranian midwives and providing strategies to improve women-centred care: A sequential explanatory mixed method study protocol.

AIM: The present study aimed to evaluate the status of WCC provided by Iranian midwives. DESIGN: A sequential explanatory mixed method study protocol. METHODS: The present study was conducted in three phases: quantitative, qualitative and mixed. The first phase is a cross-sectional study that will be performed on midwives working in health centres, public and private hospitals in Iranian. The second phase is a qualitative study, in which purposeful sampling will be used, meaning that the midwives who are part of the extreme cases according to the results of quantitative phase and are willing and able to express their own experiences regarding WCC will be selected. Also, pregnant and parturient women under their cover will also be interviewed. Finally, in the mixed phase, we will use a combination of two quantitative and qualitative studies, a literature review and expert opinion using a Delphi method to provide strategies to improve and promote WCC in midwives. RESULTS: Achieving this goal is expected to provide positive outcomes such as strengthening the midwives professional relationship with women and reducing health care costs. No Patient or Public Contribution.

The effect of probiotic supplementation on episiotomy wound healing among primiparous women: a triple-blind randomized clinical trial.

BACKGROUND: Probiotics increase the defense power of immune system and accelerate the wound healing process by anti-inflammatory mechanisms at the wound site. The present study aimed at evaluating the effect of Lactobacillus casei oral supplementation on episiotomy wound healing among primiparous women. METHODS: This triple-blind randomized clinical trial was performed on 74 primiparous women delivered in Alzahra Hospital, Tabriz, Iran. Participants with mediolateral episiotomy (incision length equal to and less than 5 cm) were randomly assigned to the probiotic and placebo groups. The probiotic group received Lactobacillus casei 431 with 1.5 * 109 colony-forming unit /capsule once a day from the day after birth to 14 days. Wound healing as a primary outcome was measured by Redness, Edema, Ecchymosis, Discharge, Approximation and pain as a secondary outcome by the Visual Analogue Scale before discharge, 5 ± 1 and 15 ± 1 days after birth. The data were analyzed using independent t-test and repeated measures one way analysis of variance. RESULTS: The mean (standard deviation: SD) score of wound healing in the probiotic group altered from 4.91(1.86) before discharge to 1.55 (0.99) during 5 ± 1 days after birth and reached to 0.95 (0.27) during 15 ± 1 days after birth. Further, the mean (SD) score of wound healing in the placebo group altered from 4.62 (1.99) before discharge to 2.80 (1.20) during 5 ± 1 days after birth and reached to 1.45(0.71) during 15 ± 1 days after birth (adjusted mean difference: -0.50, confidence interval 95%: -0.96 to -0.05, P = 0.03). CONCLUSION: Lactobacillus casei oral supplementation is effective in healing episiotomy wounds. It is suggested to evaluate the effect of topical use of Lactobacillus casei on episiotomy repair and pain in further studies. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N7. Date of registration: 11/08/2021.

Post-traumatic stress disorder among Iranian women with genital mutilation: a cross-sectional study.

BACKGROUND: The conflicting evidence on the relationship between female genital mutilation/ cutting (FGM/C) and post-traumatic stress disorder (PTSD) may be due to the differences in the prevalence and type of FGM/C in different societies. The present study aimed to assess the prevalence and severity of PTSD and its associated factors among Iranian women with genital mutilation. METHODS: This cross-sectional study was performed on 155 women with genital mutilation aged 18-45 years referred to the health centers in Mahabad, located in west of Iran from October 2020 to April 2021. The participants were selected using convenience sampling method. After obtaining the informed consent form from the participants, the first researcher in the presence of a gynecologist determined the type of genital mutilation through the gynecological examination. The data were collected using demographic and obstetric characteristics and post-traumatic stress disorder checklist (PCL5) and analyzed using SPSS21 software. Further, independent t-test, ANOVA, Pearson correlation coefficient, and multivariate linear regression were used. RESULT: All 155 women (100%) had type 1 genital mutilation. Six women (3.9%) had PTSD. The mean (SD) score of the PTSD symptoms among the women was 27.73 (6.79) in the attainable score of 0-80. The age at FGM/C, level of education, and type of residence were considered as the predictors of the severity of the symptoms of PTSD, as explaining 48.1% of the variance. CONCLUSION AND RECOMMENDATION: In the present study, the prevalence and severity of PTSD among the participants were relatively low, which may be due to convenience sampling method used in the study, the limited injury in genitalia, and the social acceptance of the practice. The results indicated that the severity of the PTSD symptoms enhanced by increasing age at FGM/C and decreasing socio-economic levels. It is recommended to conduct the similar studies among women with other types of FGM/C.

Female Genital Mutilation/cutting (FGM/C) is prevalent in the south and west regions of Iran. Raising awareness on the consequences of FGM/C is essential for its prevention. In some societies, FGM/C triggers post-traumatic stress disorder (PTSD), which is a disorder resulting from an abnormal response to a traumatic event. It is the first research in Iran on PTSD following FGM/C. Our study was conducted among 155 women with genital mutilation referred to the health centers in Mahabad, located in west of Iran from October 2020 to April 2021. The participants were selected using convenience sampling method. The participants were examined for type of genital mutilation and asked to fill post-traumatic stress disorder checklist (PCL5). All 155 women (100%) had type 1 genital mutilation and six women (3.9%) had PTSD. The mean (SD) score of the PTSD symptoms was 27.73 (6.79), ranging from 0 to 80. The PTSD symptoms enhanced by increasing age at FGM/C and decreasing socio-economic levels.

The effect of mindfulness-based counseling on the childbirth experience of primiparous women: a randomized controlled clinical trial.

INTRODUCTION: Unpleasant childbirth experience is considered as one of the important factors for cesarean preference. Limited studies have been investigated the impact of psycho-based interventions on the childbirth experience and the most effective counseling approach to promote a pleasant childbirth experience has not been clearly identified. OBJECTIVE: The present study aimed to evaluate the impact of mindfulness-based counseling on the childbirth experience of primiparous women. METHODS AND MATERIALS: This randomized controlled clinical trial was conducted on 64 primiparous with gestational age of 32 to 34 weeks referred to the perinatology clinic of Al-Zahra and Taleghani educational-treatment hospital, affiliated to Tabriz University of Medical sciences, Iran. Participants were randomly assigned into the intervention and control groups. The intervention group received eight mindfulness-based counseling sessions. The intensity of childbirth pain with VAS (Visual Analog Scale) in the active phase of labor at 8 cm dilatation and the childbirth experience questionnaire were completed by interview after childbirth. Independent t-test and ANCOVA were used to compare the outcomes between the two groups. RESULTS: After controlling the effect of confounding variables, the mean score of childbirth experience in the intervention group was significantly higher than that in control group [Mean Difference (MD): 1.79, 95% CI: 2.52 to 1.07, P < 0.01]. The mean score of labor pain in the intervention group was significantly lower than that in the control group after controlling the effect of baseline score and confounding variables [MD: -2.21, 95% CL: -3.35 to -1.10, P < 0.001]. CONCLUSION: The findings indicated that providing mindfulness-based counseling improves the childbirth experience and reduces labor pain during childbirth. However, further randomized clinical trials are needed before making a definitive conclusion. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N9. Date of registration: 16/03/2022, 25/12/1400.

The effect of cognitive-behavioral therapy and sexual health education on sexual assertiveness of newly married women.

BACKGROUND: The present study aimed at investigating the effect of sexual health education and cognitive-behavioral therapy (CBT) on sexual assertiveness (primary outcome) and sexual satisfaction (secondary outcome) of newly married women. METHOD: This RCT was conducted on 66 newly married women with cases in pre-marriage counseling centers in Tabriz, Iran. Participants were assigned into three groups using block randomization. Eight group sessions of CBT were held for one of the intervention groups (n = 22) and 5-7 sessions of sexual health education for other intervention group (n = 22). The control group (n = 22) received neither education nor counseling during the research. The data were collected using the demographic and obstetric characteristics, Hulbert sexual assertiveness index, and Larson sexual satisfaction questionnaires, and analyzed using ANOVA and ANCOVA tests. RESULTS: The mean (standard deviation: SD) score of the sexual assertiveness and sexual satisfaction in the CBT group enhanced from 48.77 (13.94) and 73.13 (13.53) before the intervention to 69.37 (7.28) and 86.57 (7.5) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the sexual health education group increased from 48.9(11.39) and 74.95 (8.30) before the intervention to 66. 94 (7.42) and 84.93 (6.34) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the control group changed from 45.04 (15.87) and 69.04 (10.75) before the intervention to 42.74 (14.11) and 66.44 (10.11) after the intervention, respectively. Eight weeks after the intervention, the mean scores of sexual assertiveness and sexual satisfaction in two intervention groups were more than that in the control group (P < 0.001), However, there was no significant difference between the two intervention groups (P > 0.05). CONCLUSION: The results of this research indicated that CBT and sexual health education are effective in improving women's sexual assertiveness and sexual satisfaction. Considering that sexual health education, does not require complex counseling skills compared to CBT, it can be used as a preferred intervention in promoting sexual assertiveness and satisfaction of newly married women. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20170506033834N8. Date of registration: 11.09.2021. URL: http://en.irct.ir .

Predictors of the worry about cancer recurrence among women with breast cancer.

INTRODUCTION: Worry about cancer recurrence is identified as the most common psychological burdens experienced by cancer patients and survivors. The present study aimed to determine the predictors of worry about cancer recurrence among women with breast cancer. MATERIALS AND METHODS: This cross-sectional study was conducted on 166 women with breast cancer undergoing chemotherapy and radiotherapy, who referred to private and public oncology centers in Tabriz, Iran using the convenience sampling. Data collection tools were demographic and disease characteristics questionnaire, cancer worry scale, social support questionnaire, brief illness perception questionnaire, international physical activity questionnaire-short form, and The EORTC-in-patsat32. The data were analyzed using SPSS 25 software. Pearson correlation coefficient, independent t-test, ANOVA, and multivariate linear regression were used. RESULTS: In the present study, the mean (standard deviation) of score of worry about cancer recurrence was 17.41 (7.88), ranging from 8-32. The results revealed that the type of surgery, illness perception, satisfaction with care, and place of treatment were the most important predictors of worry about cancer recurrence, which explained 44.3% of the variance. CONCLUSION: The enhancement of satisfaction with care and training coping strategies among individuals with high perceived severity of the illness contribute to the reduction of worry about cancer recurrence and adaptation to breast cancer.

The Effect of Psychological Interventions on Sexual and Marital Satisfaction: A Systematic Review and Meta-Analysis.

Background: Sexual and marital satisfaction play an important role in the stability of couples' relationships, so it is necessary to take a proper approach to promote them. This study aimed to identify and categorize psychological interventions affecting sexual satisfaction and marital satisfaction of women in Iran. Methods: An electronic systematic review search was conducted using the Persian and English databases of SID, Embase, PubMed, Scopus, Web of Science, Medline, Cochran library, and Google Scholar motor engine until 2021 to identify all relevant clinical trials and experimental and quasi-experimental studies assessing the effect of psychological interventions on sexual and marital satisfaction. Results: Totally, we retrieved 528 studies from the previously mentioned databases, of which, 38 met the eligibility criteria. The subgroup meta-analysis of 4 studies conducted showed that interventions based on individual consultations increase sexual satisfaction (MD: 2.94, 95% CI: -0.36 to 6.24, P= .23), (I 2 =30.83%). The subgroup meta-analysis of 10 studies conducted revealed that couple-based consultations increase marital satisfaction (MD: 5.93, 95% CI: -2.59 to 9.27, P=.95), (I 2 = 0%). Conclusion: The results of meta-analysis demonstrated the effect of counseling-based psychological interventions on increasing sexual and marital satisfaction of couples. However, further clinical trials are required before making a definitive conclusion.

The effect of shared decision-making in choosing the method of labor analgesia on childbirth experience among primiparous women.

BACKGROUND: Childbearing women reported moderate and sometimes low levels of autonomy in decision-making with their health care providers especially about their pain relief type and which may affect their childbirth experience. There is limited evidence about the effect of shared decision-making about childbirth pain relief on childbirth experience and satisfaction. OBJECTIVE: The present study aimed to assess the effect of shared decision-making in choosing the method of labor analgesia on childbirth experience and satisfaction among primiparous women. METHODS: This interventional study was conducted on 66 primiparous women with 38-42 weeks gestational age and with symptoms of labor and childbirth onset. Women were assigned into the intervention and control groups in a ratio of 1: 1 using blocked randomization. The intervention group received shared decision making about the advantages and disadvantages of labor analgesia methods, and the control group received routine care. Questionnaires, including obstetrics and demographic characteristics, Labor Agentry Scale (LAS), McKay Childbirth Satisfaction Rating Scale (MCSRS), Support and Control In Birth (SCIB) were completed. Data were analyzed by SPSS24 software and independent t-test and ANCOVA were used. RESULT: After the intervention, the mean score of childbirth experience in the intervention group was significantly higher than that in the control group [Mean Difference (MD): 6.77, 95% CI: 2.72 to 10.82, (P <0.001)]. Further, the mean score of childbirth satisfaction in the intervention group was significantly higher than that in the control group [MD: 19.06, 95% CI: 9.63 to 28.49, (P<0.001)]. The mean score of control and support during childbirth and its subscales in the intervention group was significantly higher than that in the control group after the intervention [MD: 17.21, 95% CI: 9.40 to 25.03, (P <0.001)]. CONCLUSION: It is recommended that mothers should be involved in treatment decisions during childbirth since they are considered an important part of providing care during labor and childbirth.

The effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy during COVID-19 pandemic: a ramdomized controlled trial.

BACKGROUND: Successful breastfeeding is related to the psychosocial conditions of the mother. Covid19 pandemic resulted in psychological consequences in women during postpartum period. Maternal anxiety and distress reduce the chances of exclusive breastfeeding. The present study aimed to investigate the effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy (BSE) during COVID-19 pandemic. METHOD: This randomized controlled clinical trial was conducted on 64 breastfeeding mothers referred to health care centers in Tabriz, Iran in 2021. Participants were assigned into the intervention and control groups in a ratio of 1: 1 using block randomization in a block size of 4 and 6. The intervention group participated in six individual 60-90 min sessions. Spielberger State-Trait Anxiety Inventory (STAI), postpartum distress (PMD), and BSE questionnaires were completed before and 4-week after the intervention by the control and intervention groups. Independent t-test and ANCOVA were used to compare the outcomes between two groups. RESULTS: According to the ANCOVA results by controlling the baseline values and after the intervention, the mean score of anxiety in the intervention group was lower than that in the control group [Adjusted Mean Difference (AMD): -13.82, 95%, confidence interval (CI): -12.35 to -15.29, (p < 0.001)]. Further, the mean score of postpartum distress after intervention was lower in the intervention group compared with that in the control group [AMD:5.31 95% CI: -3.00 to -7.37 (p < 0.001)]. After the intervention, the mean score of BSE in the intervention group was significantly higher than that in the control group [AMD: 25.57, 95% CI: 22.85 to 28.29 (p < 0.001)]. CONCLUSION: Stress management counseling can improve postpartum anxiety and distress and BSE and increase breastfeeding. However, more studies are needed for a definitive conclusion. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N6. Date of registration: 15/09/2021.

The effect of a childbirth preparation program including posture correction and stretching movements on lordosis and lumbar pain.

AIM: The study aimed at evaluating the effect of posture correction and stretching movements on lordosis and lumbar pain in pregnant women. BACKGROUND: An increased lumbar lordosis during pregnancy is considered one of the most common causes of lumbar pain. METHODS: This quasi-experimental study was performed on 66 pregnant women referred to health centers in Tabriz, Iran, from November 2020 to June 2021. The participants were randomly assigned to the intervention and control groups. The intervention group received training of posture correction movements and stretching exercises during pregnancy from 16 to 18 to 35-37 weeks of pregnancy in six sessions for 45-60 min. The data were collected using a flexible ruler and a visual analog scale. Independent t-tests, repeated measures ANOVA, and ANCOVA tests were used. RESULTS: The mean (standard deviation: SD) of lumbar lordosis increased from 45.12 (2.07) to 54.97 (2.20) in the intervention group at 35-37 weeks and changed from 44.28 (2.03) to 55.54 (3.39) in the control group at 35-37 weeks (adjusted mean difference: -1.24, 95% confidence interval: -2.48 to -0.005, P = 0.04). The mean (SD) of lumbar pain at 28-30 weeks was 2.80 (1.72) in the intervention group and 3.74 (2.23) in the control group (P = 0.09). However, the mean (SD) of lumbar pain at 35-37 weeks in the intervention group 4.38 (2.45) was significantly lower than that in the control group 5.83 (2.96) (P = 0.04). CONCLUSION: This study provides evidence for the potential health benefits of training posture correction and stretching movements on controlling lumbar lordosis and reducing lumbar pain during pregnancy.

The effect of counseling on women's coping with unplanned pregnancy.

INTRODUCTION: The responses to a life-changing event can be different. The study aimed to determine the effect of counseling on coping strategies among women facing unplanned pregnancy. METHODS: This quasi-experimental study was conducted on 70 unplanned pregnant women with a gestational age <10 weeks, who scored ≥ 15 in the avoidance pattern of Revised Prenatal Coping Inventory (NU-PCI). The participants were randomly assigned into the intervention and control groups. Three counseling sessions were held for the intervention group. Data were gathered using questionnaires of the women's perceptions of unplanned pregnancy, decision-making style and strategies, NU-PCI, and the checklist for the type of decision. Independent t-tests, ANCOVA, and Chi-square were used. RESULTS: After intervention, the mean score of the avoidance pattern in the intervention group was significantly lower than that in the control group [AMD: - 4.35, 95% CI: -8.7 to -0.13, P=0.03]. In addition, the continuation rate of pregnancy in the intervention group, 28 subjects (80%), was significantly higher than that in the control group, 21 (60%) (P = 0.03). CONCLUSION: The counseling leads to a decrease in the use of avoidance strategies among women facing unplanned pregnancies. Development of supportive interventions for women experiencing unplanned pregnancies is recommended specially in societies with induced abortion restrictions.

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.

The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study.

BACKGROUND: There is insufficient scientific evidence on the effect of communication skills of childbirth care providers on maternal childbirth experience and satisfaction. The present study aimed to determine the effect of communication-based care on the childbirth experience and satisfaction among primiparous women. METHODS: A total of 80 primiparous women participated in this experimental study who were randomly assigned into the intervention and control groups. According to the World Health Organization (WHO) care model, the intervention group received effective communication-based care, and the control group received the routine care. Data were collected using demographic and obstetric questionnaires, Labor Agentry Scale (LAS) and Birth Satisfaction Scale-Revised (BSS-R), and Support and Control in Birth (SCIB) scale applied 12 to 24 h after the intervention. RESULTS: After controlling the effect of confounding variables, the mean scores of childbirth experience (51.23(1.54) and satisfaction (26.03(0.81) in the intervention group were significantly higher than that in the control group (45.33 (1.54) and 22.66 (0.81) respectively; [adjusted mean difference (AMD) = 5.90, CI = 95%: 1.17 to 10.62, P = 0.01] versus AMD =3.37, CI: 95%: 0.87 to 5.87, P = 0.001]. CONCLUSION: Eeffective communication-based care improved childbirth experience and satisfaction of primiparous women. Therefore, it is recommended that health-care providers should be trained on the communication skills in the delivery room especially during a vital threatened crises such as the Covid pandemic.

The effect of decision-aid-based counseling on cervical cancer screening behavior among women: An interventional study.

BACKGROUND: Performing appropriate and regular screening can effectively reduce cervical cancer and mortality rate, however, the available evidence suggests that women's participation in cervical cancer screening remains low in middle- and low-income countries, and that it is necessary to identify appropriate intervention methods to change behavior. The present study was designed to determine the effect of decision-aid-based counseling on cervical cancer screening behavior among women. MATERIALS AND METHODS: This trial study was conducted on 154 women with no history of Pap smear during the past 3 years and refers to Tabriz health care centers. The participants were assigned to the intervention (decision aid based counseling) and control (routine health education) groups through randomized block design with block sizes of 4 and 6 and a 1:1 allocation ratio. The data were collected using the sociodemographic and fertility characteristics, stages of change checklist, and shared decision-making (SDM) and decisional conflict (DC) questionnaire before and 6 months after the intervention by interview and then, analyzed by SPSS24 software. The independent t-test, ANCOVA tests were used. RESULTS: A significant difference was observed between the two groups in terms of changing the stages of cervical cancer screening behavior 6 months after the intervention. As after the intervention, the frequency of individuals entered the preparation or action stage was more than the control group (P = 0.001). The mean score of SDM in the intervention group was significantly higher than the control group after intervention ([45.49 ± 1.18] vs. [27.56 ± 1.18] [Mean Difference (MD): 17.92; 95% confidence interval [CI]: 14.59-21.25; P < 0.001]). The mean score of DC in the intervention group was significantly lower than the control group after intervention ([29.16 ± 1.09] vs. [34.14 ± 1.09] [MD: -4.97; 95% CI: 1.09-8.04; P < 0.002]). CONCLUSIONS: This study revealed that evidence-based information communicated between clients and clinicians has very important role in clients' health-related behavior. It is recommended, health care providers apply decision-aid-based counseling for promoting the cervical cancer screening behavior among women.