Midwives’ Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study

In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as acomponent of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage naturalchildbirth practices and reduce cesarean section rates. The purpose of this qualitative study was toexplore the perceptions of midwives about conditions influencing the implementation of NCPP. In this qualitative study, data were collected through 21 in-depth semi-structured individualinterviews with expert midwives who were selected using purposive sampling mainly from one medicaluniversity in Eastern Iran from October 2019 to February 2020. Based on the framework method asa thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, wefollowed Lincoln and Guba’s criteria. Data analysis yielded 546 open codes. After the codes were reviewed and similar codeswere removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes,19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristicsof the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effectivemanagement; Institutional and social context; and Social education. Based on the perceptions of the studied midwives, the success of the NCPP is guaranteedby a set of conditions identified in this study. In practice, these conditions are complementary andinterrelated, and they cover a wide range of staff and parturient characteristics to the social context. Itseems that effective implementation of the NCPP also calls for the accountability of all stakeholders,from policymakers to maternity care providers.