Development and Implementation of Support Guideline for Improving of Childbirth Experiences among Primiparous Women in Public and Private Hospitals in Tabriz, Iran: A Sequential Explanatory Mixed Method Study

Abstract

Abstract Introduction: Experiences that women gain from their childbirth process are considered as one of the important outcomes of childbirth and these experiences will always remain with them throughout their lives. Currently, women's satisfaction and experiences with their care process are considered as quality indicators and advanced countries have focused their efforts on improving the experience of women, however, in our country there is no clear plan to improve the experience of women giving birth; the researchers therefore sought to determine the prevalence of negative childbirth experience, its predictors factors, to explain the determinants of positive and negative childbirth experiences, and strategies to improve the experience of childbirth and to examine the impact of the designed protocol on childbirth experience. Methods: This study is a mixed method study with sequential explanatory approach. The design of study in quantitative phase was cross-sectional and in this phase, the psychometric properties of childbirth experience and support and control in birth scales, prevalence of negative childbirth experience and its predictive factors among primiparous women were determined. The sampling method in the quantitative phase was cluster type and 800 primiparous women were randomly selected from all urban and suburban health centers in Tabriz. The univariable and multivariable logistic regression test was used to test the correlation between socio-demographic, pregnancy, labour and childbirth variables with the negative birth experience. Logistic regression results were reported as odds ratio (OR) with 95% confidence interval. Then, in the qualitative phase, the perception of women in terms the aspects and determinants of positive and negative experiences of childbirth from the viewpoint of 17 primiparous women was explored. Data were collected using in-depth individual interviews and note-taking and purposeful sampling. Then, by analysing the data obtained in the quantitative and qualitative phases of the study with conventional content analysis method, collecting the results of literature review and viewpoints of expert panel, protocol for improving of childbirth experiences was formulated. Based on the protocol, appropriate interventions were designed and adapted to the culture and conditions of the community. In clinical trial phase, the protocol was conducted on 30 primiparous women at Taleghani Hospital. Independent t-test was used to compare the mean scores of birth experience in the study groups. Results: The results of the quantitative phase showed that the questionnaires of childbirth experience and support and control in birth are valid and reliable scales among Iranian women. About 37% of women had a negative experience of childbirth. Probability of negative birth experience in the absence of any type of pain relief including non-pharmacological or pharmacological methods was 4.24 times more than using any type of pain relief methods. Fear of childbirth and no form of exercise during pregnancy increased the odds of negative birth experience by 3.47 and 2.81 times, respectively. The analysis of qualitative data on negative experiences resulted in the formation of 13 main categories that included disrespect and offensive behavior, unmet needs and preferences, inadequate physical and psychological space, lack of awareness about labor and delivery, lack of woman and family participation in care process, felling of fear and worry, feeling powerless in self-control, no pain relief, discomfort and suffering from unnecessary interventions, the woman's hesitation about the negative attitude of the physician and those around her about natural childbirth, mother's discomfort at not having a relationship with her baby, discomfort from maternal-neonatal complications, and dystocia. Positive experiences were also analyzed separately and it resulted in the formation of 13 main categories that included mother-child attachment, short stay in the delivery department, satisfaction with pharmacological and non- pharmacological pain relief methods, convenience and satisfaction with therapeutic interventions, appropriate physical and psychological space of the birth center, prenatal preparation, positive attitude towards natural childbirth, self-control, family support and professional support, maintaining personal dignity, participation in the process of caring, praying and trusting in God, and maternal satisfaction with the childbirth outcomes. The results of third phase resulted in the providing of 70 recommendations of improving the experience of childbirth and finally, the results of the intervention phase, showed that the implementation of the developed protocol improved the childbirth experiences of primiparous women (Mean Difference: 0.9, 95% Confidence Interval: 0.5 to 1.2; p <0.001). Conclusion: Considering the high prevalence of negative experiences and related factors, it is suggested that the developed protocol be made available to policymakers and planners to design programs with a woman-centered approach. Also, it is recommended that birth attendants also receive training on strategies to improve the childbirth experiences.