Journal of Midwifery & Reproductive health
Volume:9 Issue: 2, Apr 2021

Vaginal birth after cesarean (VBAC) is a global solution to reduce the number and complications of repeat cesarean section (C-section); however, fear of consequences is an obstacle preventing its performance. Knowledge of research available in each country provides the support needed for making decisions regarding evidence-based actions for healthcare service providers in the country. This study aimed to review the studies performed to investigate VBAC in Iran.

Search was carried out on Engliah and Persian databases including PubMed, Scopus, Google Scholar, Magiran, and SID. Retrieved articles up to October 2020 were included in the review and the search process was performed using the keywords of "Vaginal birth after cesarean", "Repeat C-section", "Trial of labor after C-section", "VBAC", and "TOLAC". All related studies without time restriction were entered into the study, resulting in a total of 12 studies.

The success rate of VBAC varied from 27%-91.2% in different parts of Iran between 1981 and 2020. Moreover, maternal and neonatal adverse outcomes and cost and length of hospitalization were lower in the VBAC group. No related maternal death was reported in all reviewed studies.

The findings of the present review indicated the lack of access to sufficient study resources on this field of research in Iran. Nevertheless, it is required to employ strategies as building an organizational culture, clinical contextualization at the level of healthcare services, and improving service environments, including VBAC supportive centers to promote this practice in the country.

Reducing cesarean section (CS) rate in order to improve maternal and neonatal health indicators is considered as one of the goals of Iran's health system transformation plan. This study aimed to examine the effect of an educational intervention based on the theory of planned behavior on selecting mode of delivery in primigravidae women with intention of elective CS.

This experimental study was conducted on 130 primigravidae women referred to health centers in Neyshabour, Iran, in 2018. Multistage sampling was performed and the subjects were randomly assigned into two groups. In the intervention group, the designed educational package was implemented in four-90-minute sessions and the control group received routine care. The theory of planned behavior constructs were measured by a self-structured tool before and after the intervention. The data were analyzed by SPSS software (version 19) using t-test, Mann-Whitney, and Chi-square tests.

The results showed that there was no significant difference between the mean score of attitude, subjective norm, perceived behavioral control and intention of primigravide women in two groups. However, after the educational intervention a significant difference was found between the control and intervention groups in terms of attitude (p <0.001), subjective norm (p <0.001), perceived behavioral control (p <0.001) and intention (p <0.001) towards elective CS.

Designing educational intervention based on the theory of planned behavior can be an effective strategy to change the positive perceptions of primigravidae women about CS and ultimately decrease the intention to elective CS.

Background & Childbirth preparation has been globally supported as an important part of safe maternity program. Birth preparedness and complication readiness (BP and CR) aimed to reduce delays in seeking care, arrival, and care during childbirth and immediate postpartum period. The aim of this study was to assess the knowledge and practice of BP and CR, as well as its associated factors, among antenatal care attendants in Bule Hora town in the Oromia region in Ethiopia. This facility-based cross-sectional study was conducted within February to June 2019. A total of 272 women were selected using systematic sampling and interviewed by previously tested structured questionnaires. Data analyzed using Epi Info (version 6.4) and SPSS software (version 25) with binary logistic regression and multiple logistic regression analyses. Out of 272 mothers, 46.3% practiced four or more BP and CR steps. Attendance in secondary school (OR=2.42; 95% CI: 1.73-5.48) and college or university (OR=4.12; 95% CI: 1.61-7.87), maternal occupation (OR=4.12; 95% CI: 2.64-9.69), having 1-3 (OR=1.49; 95% CI: 1.08-6.96) and higher than or equal to 4 prenatal visits (OR=3.54; 95% CI: 1.72-9.03), knowledge of main warning signs during pregnancy (OR=6.68, 95% CI: 4.80-11.77) and also during labor and childbirth (OR=4.54; 95% CI: 2.20-10.28), were independent predictors associated with BP and CR practice. The level of BP and CR among women in the study area was low. In general, policymakers and planners should improve BP and CR in women and provide pregnant women, their families, and communities with associated information.

Considering the importance of keeping the country population young and fertility control, particularly, in the elites and with regard to the influence of spiritual well-being on fertility behaviour and childbearing in the religious cultural context of Iran, the present study aimed to determine the relationship between spiritual well-being and fertility preferences in the selected higher education centers of Mashhad, Iran in 2019.

This correlational study was carried out on 296 married students of Mashhad University of Medical Sciences and Razavi University of Medical Sciences in Mashhad, Iran, who were selected using multistage sampling between 2018 and 2019. The data were collected using three questionnaires of individual-educational characteristics, spiritual health, and Miller's Fertility Preferences and Childbearing Questionnaire. The data were analyzed using descriptive statistics and Pearson’s correlation coefficient.

In terms of spiritual health, 222 (75.0%) students had a moderately score. Also, 143 (48.3%) subjects had a high level of willingness to have children. Regarding the number of children, 88 (29.7%) students tended to have two children, and 75 (25.9%) participants were inclined to have children within 1 to 2 years after marriage. There was a significant linear relationship between the spiritual health and fertility preferences of the students (r=0.29; p <0.001).

It is recommended to develop a codified and local curriculum for the education of spiritual health, and its impact on the fertility preferences of the students. However, further studies in this regard are suggested.

obesity can negatively affect sexual function and lower sexual satisfaction in obese people. The present study aimed to compare the effect of solution-focused group counseling and individual counseling based on the Plissit model on the sexual satisfaction of women with high body mass index.

This randomized clinical was conducted on 60 women with a BMI˃30 kg/m²  who were randomly assigned to two groups of solution-focused group counseling and individual counseling based on the Plissit model. Data collection tools included personal and midwifery information questionnaires, as well as Larson's sexual satisfaction questionnaire. Solution-focused group counseling group received eight 45-minute counseling sessions, while the individual counseling group received three 60-minute sessions of counseling based on the Plissit model. Data were analyzed in SPSS software (version 16) using Chi-square, independent t-test, Mann-Whitney, and Wilcoxon tests.

In the solution-focused counseling group, the scores significantly improved in the dimensions of quality of sex life (pre-test=30.87±5.51; post-test=38.33±1.71), sexual attitude (pre-test=26.13±2.75; post-test=29.30±0.88), desire to have sex (pre-test=21.50±3.31; post-test=23.40±1.40), and total sexual satisfaction (pre-test=102.17±13.42; post-test=115.07±4.16), after the intervention, compared to the scores obtained before the intervention (p <0.001). In the individual counseling group based on the Plissit model, the scores significantly improved in the dimensions of quality of sex life (p <0.001; pre-test=30.30±3.70; post-test=35.103±3.69), sexual attitude (P=0.01;pre-test=24.53±2.26;post-test=26.10±1.92), sexual compatibility (P=0.008; pre-test=21.80±1.61, post-test=22.67±0.99), as well as total sexual satisfaction (P=0.001; pre-test=98.93±8.46; post-test=106.17±5.10) after the intervention, compared to their scores before the intervention.

As evidenced by the obtained results, solution-focused group counseling can lead to increased sexual satisfaction of women with high BMI.

Background & Although evidence confirms the importance of vitamin D supplementation in pregnancy, there is still a debate over the adequate daily doses of vitamin D intake. This study aimed to investigate the effect of 400 and 1,000 IU vitamin D/day on maternal serum 25 (OH) D levels. This quasi-experimental study was carried out on 74 healthy pregnant women between June 12 and September 22, 2019. The intervention group (n=44) received 1,000 IU vitamin D/day from 8 to 10 weeks of pregnancy for 17 weeks, while the control group (n=39) took multivitamin supplements (400 IU vitamin D/day) from 16 weeks of pregnancy for 12 weeks. Maternal serum 25 (OH) D levels were measured at 25-28 weeks of gestation. Data were analyzed in SPSS software (version 21) through the Chi-square, Student’s t-test, Mann-Whitney U, and linear regression tests.  There was no significant difference between the two groups at the beginning of the study in terms of 25 (OH) D concentration (P=0.23). The intake of 1,000 IU vitamin D/day had a significant (β=0.28, p <0.001), yet small effect (effect size=0.30), on increasing serum 25 (OH) D levels after controlling the confounding variables. About half of the females who took 1,000 IU vitamin D/day had a serum 25(OH) D level less than 30 ng/dl at 25-28weeks of pregnancy. Even after receiving 1,000 IU/day Vitamin D, vitamin D insufficiency was still prevalent during the second trimester of pregnancy. It seems that a higher dosage of vitamin D is required for pregnant women.

Perinatal mortality is used in international scales as a reflection of the quality of maternal and newborn care. Therefore, the current study aimed to determine perinatal mortality and its associated factors at Besat Hospital of Sanandaj within 2013 to 2015.

This retrospective case-control study was conducted using medical records available at Sanandaj Besat Hospital during 2013- 2015. Sampling was conducted through the census method. Firstly, all cases of perinatal mortalities in the delivery and neonatal wards whose medical files were complete (n=466) were selected as the case group, and a file of live birth for each case was randomly chosen on the same day as the control (n=466). Data analysis was performed by SPSS 21 using the Chi-square, independent samples t-test, and logistic regression.

The rate of perinatal mortality was reported as 38.3 per 1,000 births. Parental consanguinity, parity, number of abortions, birth weight, gestational age, pregnancy and delivery complications as well as congenital abnormalities were significantly different between the two groups (p <0.05). The most important risk factors associated with perinatal mortality were prematurity (OR=15.6; 95% CI: 8.7-29.3; p <0.001), low birth weight (OR=0.6; 95% CI: 0.5-0.7; p <0.001), congenital abnormalities (OR=6; 95% CI: 2.2-16.4; p <0.001), pregnancy complications (OR=2.2; 95% CI: 1.1-4.6; p <0.03), delivery complications (OR=2; 95% CI: 1.5-4.7; p <0.001), and parental consanguinity (OR=21.7; 95% CI: 1.23-2.41; p <0.001).

Parental consanguinity, LBW, preterm birth, hypertension, and premature rupture of membranes were the most important factors increasing the risk of perinatal mortality.

Women’s economic empowerment for participation in decision making is the process of achieving women’s equal access and control over economic resources and prerequisite for the Sustainable Development Goals and pro-poor growth. Women’s economic empowerment is about rights and equitable societies and requires sound public policies. The present study aimed to determine the magnitude and factors affecting women’s economic empowerment for participation in decision making among married women at reproductive age in Assosa, western Ethiopia.

This community-based analytical cross-sectional study was conducted on a total of 342 women at reproductive age in Assosa using simple random sampling. Structured interview questionnaire that was reviewed and adapted from different literature was used to collect data from the respondents. Descriptive statistics and cross-tabulation were used to analyze the data. Multivariate logistic regression was carried out to determine the independent predictor variables.

The magnitude of women’s economic empowerment for decision-making was 39.9%. Moreover, media exposure (AOR=14.90), experience of husband-wife discussion (AOR=4.90), women's attitude toward wife beating (AOR=8.33) and knowledge of family planning practice (AOR=1.00) were more likely associated factors influencing women’s economic empowerment for participation in decision making.

Media exposure at least one times per day, husband-wife discussion on participation in decision making, women's attitude towards wife beating, and knowledge of family planning practice were the independent predictors of women’s economic empowerment for participation in decision making. Thus policy related strategies should be designed to reach these special populations to promote Women’s Economic Empowerment for Participation in Decision making.

Menopause exerts negative impacts on women's quality of life. It seems that drawing on spiritual resources can be effective in improving the quality of life among this population. Therefore, the present study aimed to determine the relationship between spiritual wellbeing and the quality of life of postmenopausal women.

This descriptive correlational study was conducted on postmenopausal women referring to Ibn Sina and Amir Hamzeh health centers in Isfahan, Iran in 2018-2019, among whom 340 cases were selected via the non-probability sampling method. The research instruments included the Spiritual Well-Being Scale (SWBS) developed by Paloutzian and Ellison and the SF-36 Quality of Life Questionnaire. Data were analyzed in SPSS software (version 21) using descriptive statistical tests and Pearson correlation coefficient.

The obtained results pointed to the positive and significant correlation of existential and religious dimensions of spiritual wellbeing with the eight dimensions of quality of life (p <0.05).

As evidenced by the obtained results, spiritual wellbeing and its components are important variables affecting the quality of life of postmenopausal women. Therefore, it is essential to design interventions aiming at strengthening spiritual/religious values and beliefs to promote the health of postmenopausal women and consequently improvement of their quality of life.

Background & The genital self-image refers to women's attitudes, beliefs, and feelings about their genitalia and genital system that are involved in sexual intercourse. Sexual assertiveness is individuals' ability to meet their sexual needs. Considering the dearth of study on women’s genital self-image, this study aimed to evaluate the effectiveness of a sexual assertiveness training program on women’s genital self-image. This parallel randomized clinical trial was performed on 60 married women referred to Imam Reza Health Center in Mashhad during September and October 2016. A sample size of 30 subjects was assigned to intervention and control groups. The training classes including two 90 minutes sessions were held once a week for 2 consecutive weeks. The tools for data collection consisted of Hulbert sexual assertiveness and women’s genital self-image questionnaires. A pretest was completed in two groups at the beginning of the study and a post-test was done for both groups one week after training the intervention group. To analyze data student t-test, paired t-test, Mann-Whitney, Wilcoxon, Chi-square and one-way analysis of variance were used. The score of genital self-image was the same in two groups before carrying out the intervention (z= -1.762, p= 0.780). However, following the implementation of training program the two groups showed significant differences and the score of genital self-image  was higher in intervention group (z = - 4.077, p ˂ 0.001).   Sexual assertiveness training can improve women’s genital self-image. So it is recommended to tailor training programs to enhance women's genital self-image, particularly, in women with sexual dysfunction in order to improve their sexual health.

Physiological, anatomical and hormonal changes that occur during pregnancy could increase pregnant women’s risk of falling, which could lead to negative outcomes for both women and fetuses. This study aims was to identify the prevalence and influencing factors of falls in Turkish women during pregnancy as well as these women’s treatment-seeking behavior.

This retrospective and descriptive study was conducted with 622 pregnant women who presented for prenatal follow-up at Niğde Training and Research Hospital in Turkey using the convenience sampling method. The data were collected with the “Structured Questionnaire Form” and “Trait Anxiety Inventory”, and analyzed using SPSS 24.0 software using descriptive statistics, Chi-squared and Student's t-tests and logistic regression analysis.

The prevalence of falls in pregnant women at term was found as 17.7%. The falls most commonly occurred at home (62.3%), on stairs (16.8%), and on wet (16.8%) or uneven ground (13.9%). The rates of injury and going to a hospital after such a fall were 63.6% and 14.2%, respectively. Trait anxiety mean scores did not show a significant difference in terms of pregnancy fall history (p>0.05).Regression analysis revealed a significant relationship between a fall history during pregnancy and medication use (OR=1.680; p=0.025) and clothing style (OR=1.836; p=0.025).

Approximately two out of ten pregnant women have a history of falling, with the falls usually being associated with preventable causes. It is recommended that pregnant women be informed by midwives and other healthcare professionals about falls, avoiding risk factors and seeking medical treatment.

 Breast cancer is one of the most common cancers and second leading cause of cancer mortalities among women. The present study aimed to measure the levels of knowledge, attitude, and practice of women regarding breast cancer screening behaviors.

 This cross-sectional study was carried out on 406 women who referred to five health centers in Mashhad and were selected using the multistage sampling technique within July 2018 to June 2019. The data were collected through a self-structured questionnaire, including four sections of demographic characteristics, knowledge, attitude, and practice towards breast cancer screening behaviors. The data were analyzed using Chi-square, Pearson's correlation coefficient and linear regression tests.

 The mean score of women’s age was 33.5±10.3 years. 49.1% and 7.9% of the participants had a low level of knowledge and negative attitudes toward breast cancer screening, respectively, which led to the poor practice of women in this regard (29.1%). According to the Pearson's correlation coefficient, the practice of breast cancer screening behaviors had a significant positive correlation with the scores of knowledge (r=0.20; P=0.04) and attitude (r=0.35; P=0.03). The findings of the linear regression of contextual variables indicated that there was a significant relationship between a family history of breast cancer and positive practice (P=0.001).

 Inadequate knowledge and moderate attitudes toward breast cancer screening led to moderate to poor practice in the majority of women. It is suggested to perform studies on the necessity of appropriate and effective educational methods on breast cancer screening behaviors.

Cesarean scar pregnancy is an ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar and is the rarest kind of ectopic pregnancy. The present study present a case of choriocarcinoma (CC) in the cesarean scar. The clinical course, findings, and treatment plan are discussed.

Case report:

 A 41-years old multi-gravid woman with a history of one previous cesarean section and three subsequent abortions was admitted to the hospital. She suffered from an unknown abnormal vaginal bleeding for two months. Β-HCG titer was 1,000 IU/L and the report of sonography showed no gestational sac. Accordingly, the patient was diagnosed with ectopic pregnancy in the cesarean scar site and, therefore, weekly usage of methotrexate was prescribed for her. Since she did not respond to the treatment, she was referred to our department in the Faculty of Medicine. The evaluation showed mass invasion through the entire uterine wall. The uterus preservation was not possible, therefore, total hysterectomy was performed. The pathology report confirmed CC in the cesarean scar.

Based on previous studies, as the number of cesarean sections increases, the possibility of complications rises, as well.  Cesarean scars implantation of CC is one of the rare complications of caesarean section. The probability of a gestational trophoblastic disease should be considered in any woman during her pregnancy. Early detection and proper management of the complications can result in a decrease in morbidity and mortality.

Background & Breastfeeding is one of the most effective strategies to reduce infant and child mortality around the world. Due to the low rate of exclusive breastfeeding in Bushehr, Iran, it seems necessary to examine its related factors. Therefore, this study aimed to investigate the prevalence and factors associated with exclusive breastfeeding in Bushehr, Iran. This study was conducted based on a cross-sectional descriptive design. The data were collected using an adopted and validated structured questionnaire from 288 mothers who attended 10 public health centers through stratified random sampling in Bushehr, Iran, during 2019. The obtained data were analyzed in SPSS software (version 24) through descriptive statistics, Chi-square test, t-test, and binary logistic regression. The mean age of the respondents was 28.48±5.50 years, and the prevalence of exclusive breastfeeding during the first three months of the infant's life was obtained at 75%.  Lower household income was associated with higher exclusive breastfeeding practice (OR: 2.21, 95% CI: 1.01-4.69.95; P= 0.04). The odds of exclusive breastfeeding practice was 2.15 times higher in mothers who were satisfied with their newborn’s sleep habits (OR: 2.15, 95% CI: 1.14-4.04; P =0.01); moreover, the corresponding value was 9.82 times higher in mothers with singleton pregnancy (OR: 9.82, 95% CI: 1.78-24.12; P=0.009). Mothers who had a sick infant were 0.45 times less likely to practice exclusive breastfeeding, compared to those who had a healthy infant (OR: 0.45, 95% CI: 0.212-0.950; P=0.03). Household income, mother's satisfaction with newborns sleep habits, singleton pregnancy and infant disease were associated with exclusive breastfeeding practice. It is recommended to identify mothers who are in high-risk groups and consider their needs to promote exclusive breastfeeding.

Background & The complications of cesarean section (CS) are greater than vaginal delivery in most cases and will be increased in repeat cesarean section. Therefore, women are not keen to choose vaginal birth after cesarean section (VBAC). The present study was conducted to explore why women with previous cesarean section do not choose VBAC. This qualitative content analysis was performed on 13 women with previous cesarean section as well as 12 health care providers, who were selected from Om-Albanin hospital in Mashhad, Iran. Data was collected through semi-structured individual interviews and two focus group with women and health care providers. The interviews were recorded, transcribed and analyzed using Graneheim and Lundman’s conventional method of content analysis (2004). The trustworthiness of data was verified by Lincoln and Guba’s criteria. The main category of "feeling of loneliness, inability and fear of VBAC" was emerged from three sub-categories including "non-supportive sociological perspectives", "inefficient care” and "psychological fear of childbirth". The mothers had conflict in choosing VBAC due to emotional, social, and care system issues. Therefore, comprehensive supports including cultural interventions for vaginal birth in order to correct women’s beliefs and enhance their knowledge as well as planning a supportive and special care system for women with previous CS will help them in decision making for VBAC. Planning for these strategies and evaluating their effectiveness are suggested.