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Cited by 49Maternal and Perinatal Health InterventionsReproductive Health and ContraceptionGlobal Maternal and Child Health

Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study

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Shirzad, Mahboube, Shakibazadeh, Elham, Betran, Ana Pilar, Bohren, Meghan A., Abedini, Mehrandokht·2019·Reproductive Health
DOI 10.1186/s12978-019-0680-2PMC PMC6368775
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Abstract

BACKGROUND: Iran has one of the highest national caesarean section rates worldwide. Few studies explored in-depth the health-facility and health-system level factors that affect women's choices on mode of delivery in Iran. The aim of this study was to explore the health-facility and health-system level factors affecting women's preferences on mode of delivery in Tehran. METHODS: We conducted a qualitative study using in-depth face-to-face interviews with women between October 2017 and May 2018. Study participants were sampled purposively from a range of health service settings to include women of varying experiences regarding childbirth. Eligibility criteria were Persian-speaking, women with or without childbirth experiences. All interviews were audio-recorded and lasted 30-45 min. After verbatim transcription of the interviews, we created a preliminary thematic framework to analyze the data. A combined inductive (themes emerging from the data) and deductive (key concepts across existing frameworks) approach was used during data analysis. RESULTS: In total, 26 in-depth interviews were conducted. Five central themes influencing women's preferences on mode of delivery emerged from the analysis: (1) health system conditions (important differences between the quality of care provided at private and public hospitals; staff shortages, skills, competency, motivation and also accessibility to staff during the longer time required for a vaginal delivery; policies and protocols on vaginal birth after cesarean, pain relief for vaginal birth, and having companion during labor; (2) standards of care in facilities (physical condition in facilities; physical examinations and procedures; continuous and organized care; ethics); (3) interaction between women and providers (communicating in a supportive manner with women and communication women's partners/families); (4) preserving women's dignity (delivering high quality and respectful care); (5) provision of information (education about pregnancy and childbirth including environment in facility, labor processes/procedures, and the risks and benefits of both vaginal delivery and caesarean section). CONCLUSIONS: Our study suggests, there are barriers to increasing demand for and satisfaction with vaginal birth, such as women's perceived sub-optimal quality of care during labor and birth, understaffed facilities that lack standard protocols and have limited physical space, and lack of privacy and dignity. The multifactorial nature of the increase of unnecessary Cesarean section calls for multicomponent interventions to revert this trend. These interventions need to address the health-systems' and health-facilities' deficiencies behind women's preference for Cesarean section.

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  • Comprehensive evidence synthesising determinants of delivery mode choice remains limited.

    “Although a number of qualitative studies have been conducted, comprehensive evidence synthesising determinants of delivery mode choice remains limited.6165”

    From Determinants of the choice of delivery mode in pregnant women: a convergent parallel mixed-methods study protocol (2026) · cites this paper as [61]

    The Background and Discussion (Strengths and limitations; page unavailable) say that several qualitative studies examined delivery-mode preferences, but that facility- and system-level factors affecting women’s choices in Iran remained understudied. This supports a limited evidence gap, not the broader claim that comprehensive syntheses of all determinants of delivery-mode choice are limited. (LLM, conf=0.82)

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Research works printed but not linked: 4

  1. [4]Gibbs RS, Karlan BY, Haney AF, Nygaard I. Danforth's Obstetrics and Gyneacology. 10th edition. Lippincott Williams and Wilkins and Wolters Kluwer. 2008.
  2. [13]Khangah HA, et al. Comparing the Health care system of Iran with various countries. Health Scope. 2017;6(1):e34459.
  3. [14]Arab-zozani M Husseini barghazan S Health Sector Evolution in Iran; A Short Review Evid Based Health Policy Manage Econ 2017 1 3 193 197
  4. [48]WHO. Recommendations on Health Promotion Interventions for Maternal and Newborn Health. 2015; Available from: https://www.who.int/maternal_child_adolescent/documents/health-promotion-interventions/en/. [cited 2018 2 January] 26180864

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Authors
Shirzad, M., Shakibazadeh, E., Betran, A. P., Bohren, M. A., & Abedini, M.
Affiliations
  • Tehran University of Medical Sciences (IR)
  • The University of Melbourne (AU)
  • Ministry of Health and Medical Education (IR)
Corresponding author
Shakibazadeh, Elham
ORCID
Venue
Reproductive Health
Publisher
Springer Science and Business Media LLC
Published
2019-02-08
Volume
16
Issue
1
Pages
15-15
ISSN
1742-4755 (ISSN-L)
DOI
10.1186/s12978-019-0680-2
PMC
PMC6368775
OpenAlex
W2923960570
Cited by
49
References
34
Citations by year
2026: 3 · 2025: 3 · 2024: 10 · 2023: 6 · 2022: 8 · 2021: 14 · 2020: 5
FWCI
7.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Reproductive Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Funders
  • World Health Organization
  • Tehran University of Medical Sciences and Health Services
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
mode of delivery, cesarean section, vaginal birth after cesarean, women's preferences, health system factors, public vs private hospitals, staff shortage, pain relief during labor, respectful maternity care, women's dignity, patient-provider communication, childbirth education, unnecessary cesarean section, Tehran
MeSH terms
Adult, Clinical Competence, Female, Health Facilities, Health Services Accessibility, Humans, Iran, Professional-Patient Relations, Quality of Health Care, Women, Qualitative Research, Delivery, Obstetric

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