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

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. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Mahboube Shirzad [verfasserIn] Elham Shakibazadeh [verfasserIn] Ana Pilar Betran [verfasserIn] Meghan A. Bohren [verfasserIn] Mehrandokht Abedini [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2019

Schlagwörter:	Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views

Übergeordnetes Werk:	In: Reproductive Health - BMC, 2004, 16(2019), 1, Seite 11
Übergeordnetes Werk:	volume:16 ; year:2019 ; number:1 ; pages:11

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/s12978-019-0680-2

Katalog-ID:	DOAJ051705311

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520			\|a 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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allfields	10.1186/s12978-019-0680-2 doi (DE-627)DOAJ051705311 (DE-599)DOAJ4a9de836f3ae4a5e9148287b10db5e78 DE-627 ger DE-627 rakwb eng RG1-991 Mahboube Shirzad verfasserin aut Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views Gynecology and obstetrics Elham Shakibazadeh verfasserin aut Ana Pilar Betran verfasserin aut Meghan A. Bohren verfasserin aut Mehrandokht Abedini verfasserin aut In Reproductive Health BMC, 2004 16(2019), 1, Seite 11 (DE-627)389462543 (DE-600)2149029-6 17424755 nnns volume:16 year:2019 number:1 pages:11 https://doi.org/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/article/4a9de836f3ae4a5e9148287b10db5e78 kostenfrei http://link.springer.com/article/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/toc/1742-4755 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2019 1 11
spelling	10.1186/s12978-019-0680-2 doi (DE-627)DOAJ051705311 (DE-599)DOAJ4a9de836f3ae4a5e9148287b10db5e78 DE-627 ger DE-627 rakwb eng RG1-991 Mahboube Shirzad verfasserin aut Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views Gynecology and obstetrics Elham Shakibazadeh verfasserin aut Ana Pilar Betran verfasserin aut Meghan A. Bohren verfasserin aut Mehrandokht Abedini verfasserin aut In Reproductive Health BMC, 2004 16(2019), 1, Seite 11 (DE-627)389462543 (DE-600)2149029-6 17424755 nnns volume:16 year:2019 number:1 pages:11 https://doi.org/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/article/4a9de836f3ae4a5e9148287b10db5e78 kostenfrei http://link.springer.com/article/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/toc/1742-4755 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2019 1 11
allfields_unstemmed	10.1186/s12978-019-0680-2 doi (DE-627)DOAJ051705311 (DE-599)DOAJ4a9de836f3ae4a5e9148287b10db5e78 DE-627 ger DE-627 rakwb eng RG1-991 Mahboube Shirzad verfasserin aut Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views Gynecology and obstetrics Elham Shakibazadeh verfasserin aut Ana Pilar Betran verfasserin aut Meghan A. Bohren verfasserin aut Mehrandokht Abedini verfasserin aut In Reproductive Health BMC, 2004 16(2019), 1, Seite 11 (DE-627)389462543 (DE-600)2149029-6 17424755 nnns volume:16 year:2019 number:1 pages:11 https://doi.org/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/article/4a9de836f3ae4a5e9148287b10db5e78 kostenfrei http://link.springer.com/article/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/toc/1742-4755 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2019 1 11
allfieldsGer	10.1186/s12978-019-0680-2 doi (DE-627)DOAJ051705311 (DE-599)DOAJ4a9de836f3ae4a5e9148287b10db5e78 DE-627 ger DE-627 rakwb eng RG1-991 Mahboube Shirzad verfasserin aut Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views Gynecology and obstetrics Elham Shakibazadeh verfasserin aut Ana Pilar Betran verfasserin aut Meghan A. Bohren verfasserin aut Mehrandokht Abedini verfasserin aut In Reproductive Health BMC, 2004 16(2019), 1, Seite 11 (DE-627)389462543 (DE-600)2149029-6 17424755 nnns volume:16 year:2019 number:1 pages:11 https://doi.org/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/article/4a9de836f3ae4a5e9148287b10db5e78 kostenfrei http://link.springer.com/article/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/toc/1742-4755 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2019 1 11
allfieldsSound	10.1186/s12978-019-0680-2 doi (DE-627)DOAJ051705311 (DE-599)DOAJ4a9de836f3ae4a5e9148287b10db5e78 DE-627 ger DE-627 rakwb eng RG1-991 Mahboube Shirzad verfasserin aut Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier 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. Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views Gynecology and obstetrics Elham Shakibazadeh verfasserin aut Ana Pilar Betran verfasserin aut Meghan A. Bohren verfasserin aut Mehrandokht Abedini verfasserin aut In Reproductive Health BMC, 2004 16(2019), 1, Seite 11 (DE-627)389462543 (DE-600)2149029-6 17424755 nnns volume:16 year:2019 number:1 pages:11 https://doi.org/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/article/4a9de836f3ae4a5e9148287b10db5e78 kostenfrei http://link.springer.com/article/10.1186/s12978-019-0680-2 kostenfrei https://doaj.org/toc/1742-4755 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2019 1 11
language	English
source	In Reproductive Health 16(2019), 1, Seite 11 volume:16 year:2019 number:1 pages:11
sourceStr	In Reproductive Health 16(2019), 1, Seite 11 volume:16 year:2019 number:1 pages:11
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views Gynecology and obstetrics
isfreeaccess_bool	true
container_title	Reproductive Health
authorswithroles_txt_mv	Mahboube Shirzad @@aut@@ Elham Shakibazadeh @@aut@@ Ana Pilar Betran @@aut@@ Meghan A. Bohren @@aut@@ Mehrandokht Abedini @@aut@@
publishDateDaySort_date	2019-01-01T00:00:00Z
hierarchy_top_id	389462543
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language_de	englisch
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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. 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callnumber-first	R - Medicine
author	Mahboube Shirzad
spellingShingle	Mahboube Shirzad misc RG1-991 misc Cesarean section misc Vaginal delivery misc Cesarean delivery misc Vaginal birth after cesarean misc Qualitative study misc women’s views misc Gynecology and obstetrics Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study
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topic_title	RG1-991 Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study Cesarean section Vaginal delivery Cesarean delivery Vaginal birth after cesarean Qualitative study women’s views
topic	misc RG1-991 misc Cesarean section misc Vaginal delivery misc Cesarean delivery misc Vaginal birth after cesarean misc Qualitative study misc women’s views misc Gynecology and obstetrics
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title	Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study
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title_full	Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study
author_sort	Mahboube Shirzad
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author_browse	Mahboube Shirzad Elham Shakibazadeh Ana Pilar Betran Meghan A. Bohren Mehrandokht Abedini
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title_sort	women’s perspectives on health facility and system levels factors influencing mode of delivery in tehran: a qualitative study
callnumber	RG1-991
title_auth	Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study
abstract	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.
abstractGer	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.
abstract_unstemmed	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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title_short	Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study
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Women’s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study

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