Challenges to Implementing Physiologic Birth Program (Pbp): A Qualitative Study of Midwives Opinion in Iran

Abstract

Background: Physiologic birth program (PBP) is one of the important strategies of the World Health Organization (WHO) to improve maternal and child's health and reduce their mortality. Although Iran has made significant progress in recent years in reducing maternal mortality, studies show that the rate of cesarean section is 3-4 times more than the recommended amount by the WHO. Also physiologic birth care has scarcely been used successfully in many hospitals and childbirth care is still offered in traditional method and based on medical interventions. Objectives: The purpose of this study was to explore challenges in implementing the PBP from perspective of midwives and obstetricians that provide maternity care in Iran. Methods: This descriptive exploratory qualitative research was conducted between 2013 and 2014 in one of the governmental medical training center in Iran. In this study, data were collected through focus groups discussions and face to face semi-structured in depth interviews with 32 midwives and 6 obstetricians working in the childbirth unit in Obstetrics and Gynecology Hospital of Khorramabad in Iran and analyzed according to conventional content analysis. Results: Data analysis identified 8 subcategories and 3 main categories. Main categories included challenges related to: the organization, professional, and laboring women. Conclusion: Results showed that improving of PBP is faced with challenges. Providing appropriate institutional context, reviewing policies and regulations, need for major reform in the student clinical education and promoting knowledge and attitude of women to normal childbirth is among the factors that health planners and policymakers should consider.