Journal of Midwifery & Reproductive health
Volume:4 Issue: 3, Jul 2016

Sexual activity is one of the most important aspects of a marital life. Childbirth is also a major event in the life of women, and the period of postpartum is a time of emotional upheaval. Since women believe that vaginal delivery could negatively affect their sexual function after childbirth, they tend to give birth through caesarean section. Therefore, this study aimed to evaluate the relationship between mode of delivery and sexual function in nulliparous women referred to healthcare centers in Mashhad, Iran.
This correlational study was conducted on 450 nulliparous women, divided into two groups of vaginal delivery and cesarean section in 2014. Suubjects were selected via multistage sampling. Data collection tools included Female Sexual Function Index (FSFI), Depression, Anxiety and Stress scale (DASS-21), and Cassidy social support scale. Data was analyzed in SPSS version 16 using Spearman correlation coefficient and Mann-Whitney test, T-test, ANOVA, and Kruskal-Wallis. Moreover, general linear model was used to control confounding variables, and P-value of less than 0.05 was considered statistically significant.
Independent t-test results indicated that mean scores of sexual function in two groups of the study were 26.11±4.36 and 26.38±4.41, respectively, which revealed no statistically significant difference between the groups (P=0.509).
No significant difference was observed between the vaginal delivery and caesarean section groups regarding sexual function. Therefore, it seems that cesarean section does not necessarily lead to pleasing sexual relationships in postpartum period compared to vaginal delivery.

Skin-to-skin contact immediately after birth plays a pivotal role in proper breastfeeding and mother-infant interaction. Despite numerous benefits of mother-infant skin-to-skin contact, this health behavior is not performed by many midwives. This study aimed to evaluate the influential factors for mother-infant skin-to-skin contact based on the Precede-Proceed model from the perspective of midwives in Torbat Heydariyeh hospitals.
This cross-sectional study was conducted on 50 midwives working in hospitals of Torbat Heydariyeh, Iran in 2015. Demographic data of all participants were collected, and Mother-Newborn Skin-to-Skin Contact Questionnaire was also used based on the Precede-Proceed model. Data analysis was performed in SPSS V.16 using descriptive statistics, tables and graphs.
In this study, 88.1% of the midwives had positive attitudes towards skin-to-skin contact, and 90.5% had high perceived self-efficacy in performing the procedure. Major obstacles against establishing proper skin-to-skin contact were neonatal diseases and maternal fatigue (83.3%) from the perspective of midwives. Moreover, 87.5% and 90.5% of the midwives emphasized the pivotal role of social support and motivation, respectively in implementing skin-to-skin contact. Also, more than 90% of the midwives considered training programs, service access and adequate facilities to be influential in the proper establishment of skin-to-skin contact.
According to the results of this study, the majority of midwives believed that enabling and reinforcing factors had significant effects on the proper establishment of mother-infant skin-to-skin contact. Therefore, it is recommended thateducational interventions be planned for parents, their family members and health care personnel involved in processes of childbirth and infant care. Furthermore, organizational planning and executive procedures should be developed to study the structures and barriers associated with skin-to-skin contact.

The prevalence of gestational diabetes during pregnancy is one of the major maternal and fetal complications. Self-care behavior could be an effective method to control gestational diabetes induced by pregnancy. The theory of planned behavior (TPB) is one of the popular conceptual frameworks for the study of human action and the prediction and understanding of particular behaviors, including self-care behavior. With this background in mind, this study was performed to evaluate the predictive factors for self-care behaviors based on TPB in patients with gestational diabetes treated with insulin.
This descriptive and analytical study was performed on 60 women with gestational diabetes treated with insulin referring to diabetes clinic of Ommolbanin Hospital in Mashhad, Iran in 2014. The samples were randomly selected and evaluated based on a researcher-made questionnaire of awareness, gestational diabetes self-care behaviors, the variables of the theory of planned behavior theory (TPB) (attitude, subjective norm, perceived behavioral control, and behavioral intention), and fasting blood glucose and two-hour postprandial blood glucose tests. Data analysis was performed in SPSS V.16 using descriptive and inferential statistics (correlation, multiple regression analysis, ANOVA, Kruskal-Wallis, and independent t-tests).
A direct relationship was observed between intention and perceived behavioral control indices and self-care behaviors. Moreover, attitude affected self-care behaviors through both intention and perceived behavioral control. With regard to total effects of the variables, perceived behavioral control was the second predictive factor for self-care after behavioral intention.
TPB emphasizes on behavioral intention and perceived behavioral control, which could be used as a framework to design educational interventions for promotion of gestational diabetes self-care behaviors in mothers.

Evaluation of prevalence of risk factors for breast cancer in different regions of Iran and identification of their significant effect on this disease can promote the prevention and reduction of breast cancer incidence. Therefore, this study aimed to evaluate the prevalence, demographic characteristics, and frequency of the risk factors of breast cancer during 10 years.
This cross-sectional study was conducted on 160 women with breast cancer during 10 years. The samples, referred by health connectors and registration centers for patients with cancer, were selected using census sampling. Research tool was a reliable and valid researcher-made questionnaire, validity and reliability of which were confirmed. Data analysis was performed in SPSS version 16 using descriptive statistics.
In total, mean age of surviving women was 50.7±1.2 years. The highest incidence rate of breast cancer was 35.2% in the group of participants aged 40-49, while the highest prevalence rate of this disease was 0.432 per 1000 samples in a group of patients aged 50- 59 years. Moreover, the most frequent risk factors for this disease were previous use of oral contraceptive pills (OCP) (56.8%) and positive family history (19%).
The results of this study were indicative of positive family history as a certain risk factor for breast cancer in Sabzevar. Therefore, it is recommended that special attention be paid to women with positive family history of breast cancer. Therefore, prioritization of breast cancer screening and prevention programs is of paramount importance in this regard.

Maternal satisfaction of health services is an inherent element of healthcare policies, and quality of midwifery care essentially influences this parameter. This study aimed to evaluate maternal satisfaction of postpartum care and its association with midwifery care at the urban health centers of Mashhad, Iran in 2012.
This descriptive, cross sectional study was conducted on 411 mothers selected via multistage sampling from 16 urban health centers in Mashhad, Iran in 2012. Data were collected using the structured questionnaire of maternal satisfaction and observation checklists to assess the technical and communication skills of midwives. Data analysis was performed in SPSS V.16.
Among the aspects of midwifery care, 92% of postnatal women were satisfied with consultation and training, 92.3% were satisfied with the technical competency of midwives, and 96.6% were satisfied with the communication skills of midwives. Moreover, high levels of maternal satisfaction of midwifery services were reported in dimensions of providing demographic and delivery history, use of dietary supplements and breastfeeding, and performing physical examinations (blood pressure measurement and scleral examination). However, no significant correlation was observed between maternal satisfaction and quality of care (P According to the results of this study, the majority of mothers were satisfied with the quality of postnatal care and midwifery services. Considering the desirable level of maternal satisfaction with the competency of clinical staff, which could not be authentically cited due to the limited information of mothers regarding professional medical care, special attention must be paid to the enhancement of the performance and responsiveness of midwives. In addition, identification of the causes of poor healthcare services in the provision of postnatal care requires further investigation.

Pap smear is a screening procedure for cervical cancer. The incidence and mortality rate of cervical cancer has decreased up to 90% in the regular screening in women aged 20-65 years. This study aimed to investigate the Pap smear reports of pathology laboratories in Ahvaz, Iran.
In this cross-sectional study, 1,006 Pap smear reports were collected from pathology laboratories via cluster sampling method. Data was analyzed by a self-structured questionnaire. In addition, variables such as age, type of infection, grade of inflammation, metaplastic changes, and epithelial cell abnormalities in cervix were studied in this study. Data analysis was performed in SPSS V.16.0 using descriptive analysis, ANOVA, Fisher’s exact, and Chi-square tests.
While no infection was reported in 94.43% (n=950) of cases, the highest incidence rate of infections in the remaining samples (5.56%, n=56) was related to Candida Albicans (4.77%, n=48). Various grades of inflammation were reported in 83.69% (n=842) of the samples. Moreover, the highest grade of inflammation in fungal infections was 2, whereas the grades in Trichomonas and bacterial infections were 1 and 3, respectively. Cervical dysplasia and metaplasia were reported in 0.29% (n=3) and 1.19% (n=12) of the cases, respectively.
The prevalence of cervical-vaginal infections, cervical metaplasia, and dysplasia were relatively low in Pap smear reports of laboratories in Ahvaz.

Abortion is the third leading cause of maternal mortality. The attitude of women towards abortion is one of the most important factors involved in this issue. This study aimed to evaluate the attitude of women of reproductive age towards induced abortion.
Methods This cross-sectional study was performed on 450 women of reproductive age in Fatemieh Hospital in Hamedan, Iran in 2014. Data was collected using abortion attitude scale consisting of five sections: socioeconomic status, family status, maternal and fetal health status, psycho -cultural background, and fertility status. Mean score less than three in each domain was considered as negative attitude, while scores higher or equal to three indicated positive attitude towards induced abortion. To analyze the data, logistic regression analysis, Chi-square and Fisher's exact tests were performed using SPSS version 21. P value of less than 0.05 was considered statistically significant.
In this study, induced abortion had no significant relationship with family status, maternal and fetal health, and fertility domains (82.1%, 77.3%, and 64.4%, respectively). A relationship was observed between induced abortion and socioeconomic and psycho-cultural domains (61.8% and 56%, respectively). Logistic regression analysis showed that the predictors of induced abortion were the attitude towards the effect of abortion on the health of mother and fetus (P= 0.01), as well as the psychocultural status of the mothers (P= 0.02).
Evaluation of the results indicated a strong belief in the majority of the participants in psychocultural and socioeconomic domains as the most significant predictive factors for induced abortion. Since it is difficult to alter the socioeconomic and psychocultural domains of individuals, changes are recommended in predominant attitudes towards induced abortion.

Despite the advantages of natural childbirth and complications associated with cesarean section, rate of cesarean delivery has increased dramatically in recent years. Therefore, appropriate training is essential to reducing this trend. This study aimed to evaluate the effects of training about the benefits of natural childbirth on the attitude and intention to select the mode of delivery in nulliparous women.
This randomized clinical trial was conducted on 64 nulliparous women with normal pregnancy at 30-34 weeks of gestation without indication for cesarean section referring to the health centers of Mashhad, Iran in 2014. Participants were randomly divided into two groups of intervention (training) and control. Training was focused on the benefits of natural delivery and performed in four sessions (60 minutes) using videos and slides. In both groups, pre-test and post-test were carried out using valid and reliable questionnaires. Data analysis was performed in SPSS V.22 using Fisher's exact test, Chi-square, Wilcoxon test, T-test, and Mann-Whitney U test.
Mean score of attitude toward natural delivery had a significant difference in the intervention group before and after training (P According to the results of this study, training on the benefits of natural childbirth could positively influence the attitude of pregnant women toward natural delivery and reduce the rate of elective cesarean section.

Healthcare areas, especially fertility care (commonly accompanied with high emotions, as well as long-term and recurring treatment periods) could exclusively benefit from patient-centered care (PCC). Despite evident advantages of PCC, this approach has not been practiced as a routine procedure in current clinical environments yet, even in western developed countries. Therefore, this review aimed to evaluate the significance and different aspects of PCC, while emphasizing on patient-centered fertility care, its challenges, and applicable recommendations in this regard.
This narrative review was conducted on 29 relevant medical and clinical papers (published during 1990-2015) collected using various national and international databases (e.g., SID, Magiran, Medlib, Google scholar, Proquest, Pubmed, Wiley, Science direct, and Scopus). Key words and phrases used in this review were “infertility”, “fertility care”, “childlessness”, “patient-centered care”, “patient-centered fertility care” “shared decision-making”, “infertile patient preferences”, and “patient involvement in fertility care”.
According to the literature, implementation challenges of patient-centered fertility care were reported as different individual and organizational factors. These factors include lack of professional motivation to change, underestimating the significance of patient-centeredness by healthcare professionals, difficulty in translation of feedback into concrete measures, lack of time and financial resources, insufficient experience of healthcare professionals with regard to identification of needs and preferences of patients, traditional organizational culture, and common misconceptions.
Promotion of patient-centered fertility services requires the identification of infertile needs and priorities of individuals, designation of interventional and supportive programs based on sociocultural characteristics of the community to fulfill such preferences, and considering patients as the most significant stakeholders of each healthcare center. This review might provide important data for healthcare professionals and policymakers aiming to improve patient-centered fertility care.

Complete bicornuate uterus is a type of Mullerian duct deformity, resulting from abnormal duct fusion. Similar to other Mullerian anomalies, bicornuate uterus is associated with specific complications during possible pregnancies. While various studies have reported successful deliveries in a bicornuate uterus, it might be accompanied with various complications, ranging from preterm labor to more catastrophic outcomes such as uterine rupture. One of the current approaches to diagnose this abnormality is ultrasound monitoring. In the present report, we presented a 25-years-old multiparous women with a history of abortion. The patient was not diagnosed with a complete bicornuate uterus in her first unsuccessful pregnancy. However, she was suspected with a complete bicornuate uterus based on the findings of ultrasound in the present pregnancy. A successful cesarean section was performed on the subject in the 39th week of gestation. According to the results, successful delivery could be achieved in patients with bicornuate uterous. Considering factors such as recurrent miscarriage, suspicious findings, and unreliable results of ultrasound, other diagnostic evaluations, including magnetic resonance imaging and hysterosalpingography, are recommended.