Document Type : Original Article
Authors
1 Department of Midwifery, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
2 Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
3 Department of Social Sciences, Faculty of Letters and Humanities, Ferdowsi University of Mashhad, Mashhad, Iran
4 Department of Community Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
Abstract
Background: Iran’s natural childbirth promotion program, part of the Health System Transformation Plan, aims to reduce cesarean section rates Evidence highlights both positive and negative impacts of the program, underscoring the need for an evaluation of its effectiveness and areas for improvement. This study investigates midwives’ experiences to identify gaps in the program’s guidelines.
Methods: A qualitative study was conducted in autumn 2022, involving 17 semi-structured interviews with midwives from Iranian medical universities. Participants were selected via purposive sampling, targeting those with at least three years of experience. Data were analyzed manually using conventional content analysis.
Results: The analysis revealed 91 codes, 8 subcategories, and 3 main themes: Gaps in the guidelines text (ambiguity and lack of clarity, neglecting key stakeholders), Neglecting the process (process-oriented weaknesses, lack of implementation context for certain provisions, incomplete and arbitrary implementation), Self-destructive outcomes (Increasing the rate of cesarean section in the long term, materialistic attitudes towards childbirth, increased unnecessary interventions, and reduced team productivity).
Conclusion: The program inadvertently promotes childbirth medicalization. To enhance its effectiveness, policymakers should revise guidelines to clarify roles, provide training for vaginal birth after cesarean, and engage stakeholders like mothers and midwives. These changes can support natural childbirth and reduce unnecessary interventions.
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