Journal of Education and Health Promotion

Abstract BACKGROUND: Pregnant women are classified as one of the vulnerable groups. Physiological and
psychological changes during pregnancy predispose them to serious psychiatric disorders; if not
identified and treated in time, it can have a negative and long‑term impact on mental health. The aim
of this study was to determine the effect of cognitive–behavioral counseling of pregnant women with
the presence of a spouse on the level of stress, anxiety, and postpartum depression.
MATERIALS AND METHODS: The present study is a clinical trial that was performed on 40 pregnant
women with a gestational age of 32–28 weeks (20 in the intervention group, 20 in the control group)
who were randomly assigned to the intervention group and the control group according to the inclusion
criteria. Cognitive–behavioral group counseling in the presence of spouses was performed by the
midwife and under the supervision of a psychologist, in eight sessions, each session lasting 90 min,
once a week for the intervention group. The control group received routine care and a counseling
session. Data collection tools were demographic information questionnaire and Depression–Anxiety–
Stress Scale 21, which were completed before the intervention, immediately after the intervention,
and on the 14th day after delivery in both groups. Data analysis was performed using statistical tests,
independent t‑test, repeated measures test, Bonferroni post hoc test, and Kolmogorov–Smirnov test.
RESULTS: The results of this study showed that the mean scores of stress, anxiety, and depression
in the two groups in the preintervention stage were not significantly different (P < 0.05), but in the
postintervention stage and follow‑up, the mean scores of stress (P < 0.001), depression (P = 0.010),
and anxiety (P = 0.029) in the intervention group were significantly reduced compared to the control
group.
CONCLUSION: According to the research findings, cognitive–behavioral group counseling can be
effective as an approach in improving the symptoms of stress, anxiety, and depression in pregnant
women. Therefore, it is necessary to plan properly to use this counseling approach to manage stress,
anxiety, and depression in women during pregnancy.

Abstract BACKGROUND: In the postpartum period, changes in sexual desire and marital satisfaction can be
seen. Learning and giving enough information on changes in pregnancy and postpartum can help
to increase marital satisfaction. The purpose of this study was to determine the effect of prenatal
training on the level of postpartum marital satisfaction in nulliparous women.
METHODS: This study is a semi‑experimental two‑group study in which 150 nulliparous women were
divided into two groups: control and intervention groups. The samples into intervention group received
routine prenatal care and eight sessions of prenatal education with a training package (educational
pamphlet on sexual health and sexual issues and an educational CD on pregnancy and pelvic
exercises), and the control group received only routine prenatal care along with a pregnancy education
pamphlet. Marital satisfaction was measured before intervention during pregnancy and 3 months
after delivery (after intervention) using the ENRICH Marital Satisfaction Scale. Data were analyzed
using t‑test, paired t‑test, Mann–Whitney, and Chi‑square test.
RESULTS: There was no significant difference in demographic and obstetric variables and pregnancy
status between the two intervention and control groups (P > 0.05). There was no significant difference
in marital satisfaction during pregnancy between the two groups (before intervention) (P > 0.05).
However, there was a significant difference in the level of postpartum marital satisfaction in the
intervention group (P < 0/05). So that, the average marital satisfaction is increased from 52.2 to 64.6.
CONCLUSION: The results of this study show that eight sessions of prenatal education class with a
training package (educational pamphlet on sexual health and sexuality and training CD of prenatal
and pelvic floor exercise) can improve postpartum marital satisfaction in women.

Abstract BACKGROUND: The most important reasons for choosing cesarean include negative attitude of
pregnant women toward natural childbirth, and it is not easy for many women to make a decision
about the choice of delivery, Midwives as responsible individuals, play an important role in providing
maternal counseling and care during pregnancy and childbirth and the postpartum period. This study
was carried out to determine the effect of individual counseling on attitudes and decisional conflict
in the choice of delivery among nulliparous women.
MATERIALS AND METHODS: This clinical trial was performed on 90 nulliparous women with
28–30 weeks of gestational age, who were referred to health‑care centers in Mashhad. They were
divided randomly into intervention and control groups. The intervention group received the counseling
program individually during three sessions, while the control group received routine care, childbirth
attitudes, and decisional conflict on choice of delivery were compared on women of 34–36 weeks
of pregnancy. Data collection tools included demographic details form, Childbirth Attitudes Scale
and Decisional Conflict Scale; data were analyzed using Chi‑square tests, Fisher’s exact test,
Mann–Whitney test, t‑test, parried t‑test, and ANCOVA in SPSS v. 16, and P < 0.05 was considered
statistically significant.
RESULTS: After consultation, there was a significant difference in attitude score between the
intervention group (86.577 ± 13.531) and the control group (69.955 ± 19.858) (P < 0.001), And there
was a significant difference in decisional conflict score between the intervention group (0.614 ± 0.626)
and the control group (1.216 ± 0.949) (P < 0.001), and there were significant differences between
the two groups in terms of preferred delivery (P < 0.001).
CONCLUSION: According to the results of this randomized control trial, individual counseling in
nulliparous women during pregnancy leads to a positive attitude toward natural childbirth, informed
decision‑making, and increase in the selection of natural childbirth.

Abstract BACKGROUND: Despite the importance of men’s role in prenatal care and its impact on the outcome
of a high‑risk pregnancy, in many countries, including Iran, men are not aware of their real needs.
Since the first step in designing any health plan is to identify the needs of the target population and
that no program can be effective without considering the actual needs of the target group, this study
aimed to identify men’s educational needs for participation in prenatal, childbirth, and postnatal care.
MATERIALS AND METHODS: In this descriptive cross‑sectional study, 280 men were selected
in Kashan city, Iran, in 2015. The sampling method was cluster sampling. The data collection tool
was questionnaire designed based on Mortazavi and Simbar’s studies that included demographic
characteristics of the subjects (14 questions) and their educational needs in terms of the content of
the training program, the training method, trainer, time, place of training, all of which were measured
by Likert scale and completed by the interview. Data were analyzed by SPSS software version 16
using descriptive statistics.
RESULTS: The findings showed that the mean age of the men participating in the study was
35.15 ± 5.83 years. Most men had high school education (45%). The three most important educational
needs of men regarding participation in prenatal and postnatal care were maternal nutrition (87.5%),
sexual health  (86.8%), and warning signs during pregnancy  (81.8%). Men preferred to receive
information from a physician (93.2%), before pregnancy (91.8%) in healthcare centers (90%). Family
was the most important source of information.
CONCLUSION: According to men’s suggestions, suitable educational programs must be implemented
by physicians in healthcare centers in classes of preparation for labor and childbirth or during prenatal
care.

Abstract Background: Pregnancy and birth are unique processes for women. Women and families
hold different expectation during childbearing based on their knowledge, experiences, belief
systems, culture, and social and family backgrounds. These differences should be understood
and respected, and care is adapted and organized to meet the individualized needs of women
and families. The purpose of this study was to explore Iranian parturient needs, values and
preferences during normal labor and delivery. Materials and Methods: An exploratory
qualitative study was used. Twenty‑four parturient women from three governmental medical
training centers in Isfahan, Iran were recruited using purposive sampling. Participants were
recruited to low‑risk women after they had given birth, but before they were discharged from
hospital. Data were collected through semi‑structured in‑depth interviews, informal observations
and field notes. Interviews were transcribed verbatim and analyzed by the conventional content
analysis according to Graneheim and Lundman approach. Results: Women’s needs and
expectations fell into seven main categories: Physiological, psychological, informational, social
and relational, esteem, security and medical needs. All of the key needs in these data relates to
a fundamental need, named “sense of control and empowerment in childbirth.” Conclusion:
Knowing a woman’s needs, values, preferences and expectations during normal labor and
delivery assists healthcare professionals especially midwives in providing high‑quality care to
parturient women.

Abstract Background and Objective: Depression is one of the most common and specific problems
during pregnancy and after it. Maternal postpartum depression compromises mother’s health
and affects social relationship, and has negative effect on infant development. The aim of
this study was to investigate the prevalence of postpartum depression and its related factors
in Isfahanian mothers. Materials and Methods: This is a cross - sectional study. The study
populations were 133 women who at the last 8-4 weeks of labor referred to Isfahan health
centers. Demographic information and obstetric and Beck Depression Inventory were applied.
Three categories emerged according to the degree of scale: Mild, moderate, and severe
depression. Statistical analysis was used with the Pearson correlation and linear regression
in SPSS version 18. Results: A total of 73 mothers had mild depression (10-19) and 56 had
moderate depressions (20-29). Among the factors related to depression such as maternal
education, financial status, unwanted pregnancy, premenstrual syndrome, and maternal
occupational history, there was a significant correlation with postpartum depression (P > 0.05).
Variables in the regression analysis include maternal education, financial status, unwanted
pregnancy, history of premenstrual syndrome, maternal occupation, type of delivery, history
of miscarriage, and having a satisfaction with baby gender. And, a total of 27.7% variance
explains the postpartum depression. Among these factors, the predictive variables of maternal
education, type of delivery, financial condition, unwanted pregnancy, premenstrual syndrome,
and maternal occupational history were significant in the meantime; the prediction of unplanned
pregnancy was more than other variables (ß = 0.24). Conclusions: With attention to factors
associated with postpartum depression, the healthcare planner will help to better manage the
problem. The results of this study will help to better understand the factors influencing mothers
in the labor process, and mothers in the labor
process, experiences minimum mental health
disorders.