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Research Article: Development of a modified physiological birth programme integrated into Iran’s health system and its effect on maternal and neonatal outcomes: an embedded mixed-methods study protocol

Date Published: 2023-08-07

Abstract:
Introduction As recommended by the WHO, promotion of physiological birth is a main strategy to reduce the rate of caesarean section and achieve Sustainable Development Goals. A modified version of the physiological birth programme that may be included into the Iranian healthcare system was developed as a result of this mixed-methods research. Methods and analysis This embedded mixed-methods study had a qualitative phase that was conducted before a clinical trial. This qualitative phase was conducted via semistructured in-depth targeted interviews with the recipients and the providers of physiological birth programme services. Data analysis was performed using a conventional content analysis approach. Then, for designing the intervention, national and international guidelines of physiological birth were reviewed, and a panel of experts was convened using the Delphi method. A randomised controlled trial was used in the second phase of the research to examine the impact of the physiological birth programme’s intended intervention on maternal and neonatal outcomes as well as mothers’ experiences during labour. It was conducted on 252 eligible pregnant women in two intervention and control groups. Finally, the results of qualitative and quantitative phases contributed to developing a physiological birth programme which can be integrated into the Iranian health system. Ethics and dissemination This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.050). All participants gave their informed permission. The study’s findings will be shared via the publishing of peer-reviewed articles, talks at scientific conferences and meetings with related teams. Trial registration number Iranian Registry of Clinical Trials (IRCT20220406054438N1).

Introduction:
In recent decades, the rate of caesarean section has significantly increased in the world from less than 7% in 1970 to more than 21% in 2018, and is predicted to rise to 28.5% by 2030. 1 Based on the WHO statement, since 1985, the international healthcare community considered the ideal caesarean rate to be less than 10%. Despite this, the number of caesarean sections, one of the most common surgical procedures worldwide, is rising quickly. The caesarean rate in Iran was 45.5% according to the most recent WHO data…

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