Journal of Midwifery & Reproductive health
Volume:10 Issue: 2, Apr 2022

Due to the significance of randomized controlled trials (RCTs) in evidence-based care, it is essential to evaluate the quality of reporting of published RCTs in order to apply the results of trials in the field of breastfeeding counseling and training.

In this critical review, the related articles were identified via searching in the English databases including Scopus, PubMed, Cochrane Library, and Google Scholar as well as Persian databases of SID, Magiran and IranDoc, using the relevant keywords. All the articles published from 2010 until 2021 were retrieved. Data collection tools included demographic questionnaire and CONSORT checklist. The quality of clinical trials was evaluated by two assessors using CONSORT 2010. The scoring range was 0-44.

A total of 17 articles were critically appraised. The overall compliance rate of the articles with the items in the CONSORT checklist was 49.2%. The greatest weakness in reporting was observed in the title and abstract (1.00± 0.35). The mean total score of quality of reporting was 18.35±3.33, with the minimum and maximum scores of 12 and 25, respectively.

The appraised articles had an average quality. It is necessary that RCTs be conducted and reported in accordance with standard principles and be thoroughly reviewed critically with relevant checklists including CONSORT. Training of researchers can help to improve the quality of clinical trial reporting.

The rate of exclusive breastfeeding has declined in the world and therefore protection, promotion, and support of breastfeeding are considered to be a public health priorities. This study was conducted to explore breastfeeding mother’s perceptions and experiences of appraisal support needs.

A qualitative study carried out between 2017 and 2019, in five health centers, four hospitals, and two physicians’ offices affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. Thirty three breastfeeding mothers, family members, and healthcare providers selected, purposively, for individual semi-structured in-depth interviews. Data were analyzed using directed content analysis adopting Elo and Kyngas approach.

Four categories and nine subcategories emerged in this study. The first category was 'affirmation from significant others' which contained two subcategories of ‘the need for approval from healthcare providers’ and ‘the need for affirmation from the husband and family members’. The second category was ‘the necessity of avoiding social comparisons due to unpleasant corollaries’, which had two subcategories: ‘unpleasant feelings caused by being compared to others’ and ‘being blamed when compared with others’. The third category was ‘offering constructive feedback’ with two subcategories of ‘providing positive feedback’ and ‘not giving negative feedback’. The fourth category was ‘persuasion’ which had three subcategories of ‘the need to encourage, ‘the need to be admired and ‘the need to be praised by significant others.

Mothers need appraisal support to protect, promote and maintain established breastfeeding. Significant others have an important role in meeting the appraisal support needs of breastfeeding mothers.

Corona-Virus is a serious infectious disease that was rapidly spread worldwide and caused considerable anxiety among people. Pregnant women are more prone to increased anxiety caused by the Covid-19 epidemic. This study was performed to evaluate the relationship between health anxiety and prenatal distress with choosing mode of delivery among pregnant women during COVID-19 epidemic in Iran.

This cross-sectional study was performed on 200 nulliparous pregnant women referred to the health centers of Ahvaz to receive the routine prenatal care. The questionnaires used were demographic, the health anxiety index-short form, and the prenatal distress questionnaire. At the end, the participants were asked by two questions whether their views on the mode of delivery has changed during COVID-19 epidemic.

A significant difference was observed between choosing mode of delivery before and after the onset of the covid-19 epidemic (P=0.012). Health anxiety and prenatal distress score was higher in women who selected cesarean section (P<001) after the onset of the epidemic. Also, the maternal concern for fetal health was significantly higher in mothers who chose cesarean section than in women who chose vaginal delivery (P=0.014).

The findings of the current study showed that higher health anxiety and prenatal distress in pregnant women during the COVID-19 epidemic caused a significantly higher probability of selecting cesarean section as a mode of delivery. Therefore, it is very important to promote the mental health of pregnant women during the epidemic.

Reproductive motivations are important factors in childbearing. The present study aimed to determine the effect of group counseling based on motivational interview on the motivation of childbearing in female students.

This randomized controlled trial was conducted on 70 eligible single female students studying at Mashhad University of Medical Sciences, Mashhad, Iran, who passed the course of family and population knowledge, and randomly assigned to the intervention and control groups. The intervention group received three 60-90 minutes sessions of weekly group counselling consisting of 10-12 individuals as well as virtual counselling through webinar, based on motivational interview. Data collection tools included a questionnaire on demographic data, Miller Childbearing Questionnaire and the Reproductive Preference Questionnaire, which were completed on a self-report basis before, immediately and four weeks after the intervention. Data was analyzed using independent t-test, Mann-Whitney U test, paired t-test, Chi-square and Fisher's exact test.

Before the intervention, the mean total score of positive and negative motivation of childbearing in female students was not statistically significant in the two groups. After counseling intervention, the score of positive motivation of childbearing increased (P<0.001), whereas, the total score of negative motivation (P<0.001) decreased, significantly, in the intervention group compared to the control group.

Group counseling based on motivational interview was effective on promoting the motivation of childbearing in female students. Therefore, it is suggested that the present counseling intervention be commonly used in order to promote the motivation of childbearing in female students.

Considering that the world’s female prison population has increased by about 53 per cent since 2000, the phenomenon of pregnancy in prisons is also increasing. One of the basic and specific needs of pregnant women is to receive prenatal care in prison. The purpose of this study was to understand the meaning of prenatal care in lived experience of imprisoned pregnant women.

The present qualitative study was conducted using interpretive descriptive phenomenology through interviews with 11 pregnant and early postpartum women in prison. The participants were purposefully selected from pregnant women imprisoned in 2020 in Mashhad, Iran. Van Manen's six-step phenomenological approach was used for data analysis.

The main theme of the "fence of deprivation" emerged from the analysis. This theme consisted of two sub-themes including “overlooked healthcare” and “limited welfare services”. According to the research findings, the deficiencies and deprivations that surrounded pregnant women in prison cause health problems and impaired welfare for incarcerated women during pregnancy.

The experience of prenatal care in prison can be likened to being placed in a fence of deprivation. Prisons are neither able to provide healthcare essentials nor to identify the healthcare needs as well as special needs and wants during delivery for pregnant women. Our results suggest a reexamination of the services currently available, including strengthening healthcare provision and making sure required health information is available to incarcerated pregnant women at an early stage of pregnancy.

Pregnant women are concerned about their health as well as their infants during the COVID-19 pandemic. The present study was conducted to investigate the effect of virtual education on fear caused by COVID-19 in pregnant women.

This quasi-experimental study was conducted in Dezful, Iran from November to January 2016. Seventy-three women were assigned to two groups of intervention (n=37) and control (n=36). Virtual training was implemented for the intervention group through sending a combination of audio and video files, educational videos, educational messages and messages for relaxation techniques every three days for four weeks during pregnancy, childbirth and hospital stay. The self-structured questionnaire of pregnant women’s fear of COVID-19 was used to collect data two weeks after intervention. Paired t-test, Independent T Test , Chi-square, McNemar, and Mann-Whitney U tests were used for data analysis.

After the intervention, the mean score of fear caused by COVID-19 significantly decreased in pregnant women of the intervention (65.48±12.50) compared to the control group (92.22±14.03) (P<0.001). Also, the level of fear of Covid-19 significantly reduced in the intervention (86.5% moderate vs 13.5% severe fear) compared to the control group (8.3% moderate vs 91.7% severe fear) (P<0.001).

Virtual education reduces the fear of pregnant women caused by COVID-19 pandemic. Therefore, they are motivated to attend prenatal visits more regularly and this can improve pregnancy outcomes. Virtual education is therefore recommended to be used in health centers and midwifery clinics during Covid-19 pandemic.

There is sufficient information about female sexual function, but few studies have investigated postpartum female sexual function. Postpartum women’s sexual function may be dramatically affected by childbirth. This study aimed to explore women's perceptions and experiences of the concept of postpartum sexual function.

This qualitative study was conducted using a directed content analysis approach based on Female Sexual Function Index (FSFI) between 2018 and 2019. Data were collected through semi-structured interviews with 13 women referred to the health centers of Babol University of Medical Sciences, Babol, Iran and were selected, purposively. The data were analyzed manually using directed content analysis adopted by Hsieh and Shannon (2005).

Overall, eleven categories emerged from the analysis. The six emerged categories were related to the predetermined components, namely sexual desire, arousal, lubrication, pain, orgasm, and satisfaction. The remaining five newly emerging categories included changes in the frequency of sexual intercourse, disturbed situation, changes in intimacy and relationship, physical (anatomical) changes, and psychological consequences.

The results showed some new categories, in addition to the components of FSFI, which could be added to the concept of sexual function in postpartum period. Therefore, health service providers should consider these new additional concepts in the assessment, care, and treatment of female sexual dysfunction in postpartum women.

Anxiety in pregnant women can have negative perinatal consequences. The aim of this study was to determine the effect of shared decision making on anxiety and satisfaction of decision about mode of delivery in pregnant women with a history of previous cesarean section.

In this clinical trial, 78 pregnant women with previous cesarean section referred to the community health centers in Torbat-e Jam, Iran were selected and randomly assigned to the intervention and control groups. The Spielberger Anxiety Inventory was completed by the pregnant women at 24-30 weeks of pregnancy. In the experimental group, in addition to routine care, a counseling session based on three-stage shared decision making was held by a midwife and a supplementary counseling session by a gynecologist. The Anxiety Inventory was completed at 35-37 weeks of gestation and the Decision Satisfaction Questionnaire was completed 8 weeks after delivery for mothers in both groups in the community health centers and questions were asked about mode of delivery. Data were analyzed using Mann-Whitney, Chi-square, student t-test and paired t-test.

After the intervention, the total anxiety score of pregnant women in the intervention group was lower than the control group and the difference between the two groups was significant (70.35±11.90 vs. 75.51±6.64; P=0.02). The score of decision satisfaction two months after delivery was higher in the intervention group than the control group and there was a statistically significant difference between the two groups (21.87±3.18 vs. 19.94±3.13; P=0.008).

Shared decision making as a practical and effective approach can reduce the anxiety score and increase the score of decision satisfaction in pregnant women with a history of previous cesarean section.

The prevalence of anxiety and fear of childbirth (FOC) during pregnancy is high. This study aimed to measure the effect of group counseling with Beck′s cognitive therapy on anxiety and FOC in primiparous women.

This randomized controlled trial was conducted on 68 primiparous women who referred to the health centers of Ardabil, Iran. The participants were randomly assigned to the counseling and control groups. The intervention group participated in six, 60-minute weekly sessions of cognitive group counseling. All women completed the Spielberger State-Trait Anxiety Inventory (STAI) before the intervention and during the active phase of labor. A questionnaire for the measurement of fear of childbirth (W-DEQ version A) was completed before the intervention, at the 36th week, and also two hours after delivery (W-DEQ version B). Mackey Childbirth Satisfaction Rating (MCSR) and childbirth experience questionnaire were completed 12 to 24 hours after delivery. Data were analyzed using Chi-square, independent t-test, ANCOVA, and repeated measures ANOVA.

There was no statistically significant difference between the two groups in terms of mean scores of state (P=0.842) and trait (P=0.859) anxiety during labor, FOC after the intervention (P=0.566), childbirth experience (P=0.400), and childbirth satisfaction (P=0.828). Also, there was no statistically significant difference in the frequency of vaginal delivery between the two groups (P=0.856).

The findings of the present study showed that Beck′s group cognitive therapy was not effective in reduction of anxiety and FOC. Therefore, it is recommended to do more research in this regard in the future.

Cesarean section (CS) results in about twice the blood loss as vaginal delivery. Blood loss can cause decreased hemoglobin and hematocrit. Few studies have been done on the effect of tranexamic acid on hemoglobin and hematocrit levels after delivery with controversial results. This study was therefore designed to determine the effect of intravenous tranexamic acid on hemoglobin and hematocrit after CS in women at low risk for postpartum hemorrhage.

This randomized controlled trial was performed on 50 pregnant women referred to Izadi hospital, Qom, Iran, from August 15, 2016 to April 30, 2017. Subjects were randomly assigned into two groups of 25 using block randomization. The intervention group received 1 gr tranexamic acid 10 minutes before CS, while the control group received 1 gr distilled water. Hemoglobin and hematocrit were measured before and 12-24 hours after delivery. Also, the volume of blood loss from placental delivery was measured 2 hours after delivery. T-test was used to compare the differences between the two groups.

There was no significant difference in pre-operative and 12-24 h postoperative hemoglobin (12.17±1.21 vs 11.72±0.99 mg/dl) and hematocrit (37.73±2.38 vs 36.22±2.41mg/dl) in the two groups (P>0.05). However, Tranexamic acid significantly reduced the volume of total blood loss from placental delivery in the first 2 hours after delivery (616.32±176.87 vs 731.45±178.79mg/dl, P=0.028).

Reduced blood loss after tranexamic acid was not associated with improvement of post-operative hemoglobin and hematocrit. Therefore, tranexamic acid should be prescribed according to the clinical condition and possible complications.

Vaginal birth after cesarean section is a strategy which is recommended to reduce repeat cesarean section. Concerns about its complications can cause crisis in decision making. Therefore, this study was performed to investigate the effect of supportive interventions on decision self-efficacy and decision conflict in mothers with previous cesarean section to choose mode of delivery.

This randomized clinical trial was carried out on 60 pregnant women with a history of previous cesarean section and gestational age of 28-30 weeks, who referred to the health centers in Bojnourd, Iran in 2020. The participants were randomly divided to intervention and control groups. Supportive interventions in the intervention group included in-person supportive counseling approach via three 45-minutes sessions per week, telegram channel, educational pamphlet and telephone. Data was collected in both groups before and four weeks after intervention by valid and reliabe decision self-efficacy and decision conflict questionnaires. The analysis of data was done by SPSS software (version 25) using independent t-test, paired t-test and Mann-Whitney.

There was a statistically significant difference in mean scores of decision self-efficacy (P =0.005) and decision conflict (P=0.010) in the intervention group four weeks after supportive interventions. While, the difference in mean scores of these variables was not significant in the control group.

Supportive interventions could help to improve the decision self-efficacy and decrease decision conflicts in mothers with previous cesarean section to choose vaginal birth after cesarean section. It can be recommended as an effective strategy to promote natural birth.