Journal of Education and Health Promotion

Abstract BACKGROUND: In the last 20 years, the public health community has expressed concerns over
the unprecedented increase of cesarean section (CS) delivery. Rising global concerns over this
escalation that has gone out of control should not be overseen. The purpose of this study is to
develop an application‑based education model and prenatal yoga to reduce the occurrence of
cesarean section (CS) delivery.
MATERIAL AND METHOD: This studywasan exploratory mixed methodsresearchthat consisted of
twostages: stage 1, which wasa qualitative study on model formulation through in‑depth interviews
and forum group discussions (FGDs); and stage 2, which aimed to test whether the formulated model
was effective in reducing the occurrence of cesarean section delivery.
CONCLUSION: The result of this study wasused todevelop an application‑based education model,
which wascombined with prenatal yoga, to reduce the occurrence of cesarean section delivery.

Abstract INTRODUCTION: Childbirth is regarded as an important life event for women, and growing numbers
of them are making the choice to give birth by cesarean delivery. Increasing rate of births by cesarean
section is an issue of concern in many countries. In order to reduce the rates of unnecessary cesarean
sections, it is essential to acquire information of the reasons that motivate physicians to carry out
cesarean sections rather than vaginal deliveries. The objective of present study is to evaluate whether
the education process for undergraduate medical students affects their decision‑making.
MATERIALS AND METHODS: The present study was cross‑sectional and questionnaire based.
A total of 292 students participated in the study. Out of which, 150 were first‑year students and
142 were doing internship in Maharashtra Institute of Medical Education and Research (MIMER),
Talegaon Dabhade, Maharashtra, India. The study was conducted in the months of June and July
2019. Data was collected with the help of person to person interview of all the participants who
satisfied the inclusion criteria after obtaining their informed consent. The data was entered by using
Microsoft Excel 2007 and was analyzed using Epi Info version 3.3.2. The data was tabulated and
analyzed according to responses which were given by the respondents.
RESULTS: A total of 292 students answered the questionnaire. Age of participants varied between
19 and 23 years. 130 males and 162 females were the subjects, out of which 40 students declared
fear of labor. Most of the students preferred vaginal delivery over cesarean sections in all the four
scenarios. The difference of opinion was significant in case of an uneventful pregnancy and normal
pregnancy under their care. For general population as healthcare manager this difference of opinion
was not significant. In case of one’s own or partner’s delivery, internship students preferred cesarean
section but this difference was statistically non‑significant.
CONCLUSION: Most of the students would recommend vaginal delivery because this form of delivery
has fewer risks as compared to cesarean section. Majority of students chose vaginal delivery for
the birth of their own child; however, a higher number of interns as compared to first year students
preferred cesarean section. Pain associated with vaginal delivery was the most common reason
given for choosing cesarean section. The student’s preference for childbirth changed in due course
of graduation toward cesarean section. This indicates a probable effect of medical education on
permissive culture of cesarean section as a mode of delivery.

Abstract BACKGROUND: Pain and nausea and vomiting are of serious complications following the use of
opiates after surgery, especially cesarean section. Control of postoperative complications is one of
the necessities of quality promotion of health‑care system. Medications with few side effects such
as corticosteroids including dexamethasone can be an appropriate option. In addition, the route of
administration can have a significant effect on the effectiveness of the drug. The aim of the present
study was to compare the effects of intrathecal with intravenous dexamethasone in reducing the
complications associated with intrathecal morphine after cesarean section.
MATERIALS AND METHODS: The study was a double‑blind randomized controlled clinical trial and
determined the effect of intrathecal and intravenous dexamethasone on the incidence and severity
of complications of intrathecal morphine after cesarean section on 120 patients and its relationship
with serious complications after surgery. Descriptive and analytical statistics were used to examine
the characteristics of the case and control groups, and STATA SPSS software was used to compare
the two groups.
RESULTS: There was no significant association between the two groups in terms of baseline
characteristics. Pain score in the intrathecal injection group was lower than the intravenous injection
group, with a statistically significant difference (P = 0.02). In addition, there was a significant
association regarding to the incidence of nausea, vomiting, and itching between intrathecal and
intravenous injection groups (P = 0.008).
CONCLUSION: Dexamethasone was effective to reduce opiate complications after cesarean section.
Establishing a suitable association between dexamethasone half‑life, efficacy, type of use, and time
of use can result the best outcomes and promote patients’ satisfaction in cesarean section.

Abstract BACKGROUND: Anxiety before and pain intensity after cesarean section is among the factors that
should be taken into consideration among the candidates for cesarean section. The present study
aimed to investigate the effect of familiarity with cesarean section and the operating room environment
on anxiety and pain intensity among the mothers undergoing cesarean section.
METHODS: This clinical trial was conducted on 80 women referred to the hospitals affiliated to
Shiraz University of Medical Sciences for cesarean section in 2018. The participants were randomly
divided into a control (n = 40) and an intervention group (n = 40). The intervention group took part
in four educational sessions, while the control group received the hospital’s routine care. The Beck
Anxiety Inventory was completed by the two groups before and after the intervention. The McGill Pain
Questionnaire was also filled out by the two groups in the ward after the cesarean section. After all,
the data were entered into the SPSS software, version 21, and were analyzed using independent
t‑test and ANCOVA.
RESULTS: The results showed no significant difference between the two groups regarding the
mean score of anxiety prior to the intervention. After the intervention, the mean score of anxiety
was 7.98 ± 3.77 in the intervention group and 19.70 ± 6.45 in the control group, and the difference
was statistically significant (P < 0.0001). Indeed, the mean intensity of pain was 43.98 ± 7.63 in the
intervention group and 57.75 ± 10.69 in the control group after the intervention, and the difference
was statistically significant (P < 0.017).
CONCLUSION: The patients’ familiarity with cesarean section and the operating room environment
caused a decline in the anxiety level prior to cesarean section as well as a decrease in the score
of pain after the operation. Hence, midwives and nurses have to play effective roles in decreasing
pregnant women’s anxiety and pain through identification of strategies for empowering them and
managing their worries.

Abstract BACKGROUND: Negative attitudes toward vaginal delivery are an important reason for pregnant
women to undergo a cesarean section. Therefore, this study was performed to evaluate the effect
of motivational interviewing on attitude and choice of primigravida women on type of delivery in
requesting elective cesarean section.
MATERIALS AND METHODS: In this single‑blind clinical trial, 120 primigravida women in
28–31 weeks of gestation with normal pregnancy determined by a multistage sampling were randomly
chosen from ten health centers of Zahedan city in 2019 and were divided into two groups. Motivational
interviewing was performed in four sessions within 90 min in the experimental group, and the
control group received routine care service. Attitude (before and 1 month after the intervention) and
performance (after delivery) were evaluated using a valid and reliable researcher‑made questionnaire.
The collected data were analyzed using different proportions, paired t‑test, independent t‑test,
covariance analysis, and Shapiro–Wilk and the Chi‑square methods.
RESULTS: There was a significant difference in the attitude of participants between the two groups
after the intervention (P = 0.001). The mean difference of pre‑ and posttest was significant in relation
to attitude scores in the two groups (P = 0.001), and the difference between the two groups was also
statistically significant between the two groups in terms of delivery type (P = 0.03).
CONCLUSION: We conclude that motivational interviewing can be a useful tool to change the attitude
and decrease the rate of unnecessary cesarean among pregnant women. It is recommended to
examine the impact of this method on women from different societies who have various educational
backgrounds and cultures.

Abstract PURPOSE: Postpartum period is a critical interval in which the woman is under risk for psychiatric
disorders including postpartum depression (PD). This study was performed to investigate the impact
of the mode of delivery on the occurrence of PD in primiparous mothers.
MATERIALS AND METHODS: This correlational study was performed on 244 primiparous
women (aged 15–49 years) in 17 primary health‑care centers. Sociodemographic, obstetric, and
PD‑related data were gathered using questionnaires and the Edinburgh Postnatal Depression
Scale (EPDS) on the 1st and 3rd months after delivery. The questionnaires were administered to all
primiparous mothers who were registered to the relevant health-care center. Questionnaires were
administered by the researcher for 25–30 min with face-to-face interview technique.
RESULTS: Comparison of EPDS scores on the 1st and 3rd months indicated that there was a
remarkable decline over time (Z = 11.112, P = 0.001). There was an inverse association between
educational level and EPDS scores on the 3rd month (P = 0.037). On the other hand, no significant
relationship was detected between age groups, occupation, income, place of accommodation, and
EPDS scores. Evaluation of the relationship between obstetric features and EPDS scores revealed
that desired and performed modes of delivery, induction, episiotomy, and spinal anesthesia were
not linked with EPDS scores. The postpartum behavior (2=10.315; P = 0.035) and feeding method
of infants (2 = 6.109; P = 0.013) were associated with EPDS scores on the 1st month, but not with
EPDS scores on the 3rd month.
CONCLUSION: Effective measures must be established for early recognition of factors affecting the
occurrence of PD. Health planners and policymakers must spend their efforts for promotion of the
knowledge and attitudes of mothers during pregnancy. Identification of factors for PD necessitates
implementation of multicentric, controlled trials on larger series.

Abstract BACKGROUND: Mortality and disability rates were reported to be respectively 2‑3 and 5‑10 times
higher in C‑sections compared to Vaginal delivery.
OBJECTIVES: This study was aimed to explore the factors involved in selecting the birth type among
primiparous women.
METHODS: The present cross‑sectional research was conducted on 220 primiparous women,
who visited the health‑care centers of Bandar Abbas. They were recruited in their first trimester of
pregnancy with a simple randomized clustering method. Data were collected in a researcher‑designed
questionnaire. Its validity was confirmed by a panel of experts and reliability was tested and approved
through the test–retest method. Mean, standard deviation, independent sample t‑test, and Chi‑squared
tests for data analysis were done by SPSS 16. P < 0.05 was considered statistically significant.
RESULTS: The mean age of the participants was 27.40 ± 6.07 years. The main barriers to the choice
of vaginal delivery were the fear of pain and fear of vaginal area tears and ruptures, fear of injury to
fetus, and doctor’s recommendation. A statistically significant correlation was observed between the
age, education, employment, income, awareness, and the reasons for preferring surgical childbirth.
CONCLUSIONS: To reduce the rate of unnecessary cesarean sections (C‑section), the following
recommendations are suggested: Reducing fear of pain in expectant mothers, modifying wrong
beliefs about the culture of natural childbirth, increasing awareness of fewer adverse effects of
vaginal delivery including the vaginal tears if the mother abides by all midwife(s) instructions during
the delivery procedure, providing educational courses for the necessary movements during the
delivery, decreasing surgeons’ payment for C‑section, and increasing payment for natural childbirth
and implementing barriers for optional delivery to reduce the C‑section.

Abstract Background: Postpartum period is the riskiest time for mood disorders and psychosis.
Postpartum depression is the most important mood disorder after delivery, which can
be accompanied by mother-child and family relationship disorders. Meta-analysis with
the integration of research results demonstrates to investigate the association between the mode
of delivery and postpartum depression. Materials and Methods: This meta-analysis uses the
Rosenthal and Robin approach. For this purpose, 18 studies which were acceptable in terms of
methodology were selected and meta-analysis was conducted on them. Research instrument
was a checklist of meta-analysis. After summarizing the results of the studies, effect sizes were
calculated manually and combined based on meta-analysis method. Results: The findings
showed that the amount of effect size (in term of Cohen d) of delivery mode on postpartum
depression was 0/30 (P < 0.001). Conclusion: Delivery mode on maternal mental health is
assessed medium. Meta analysis also indicates moderator variables role, and researcher must
focus in these variables.

Abstract Background: Normal vaginal delivery (NVD) is the best method of delivery, but its rate is
decreasing. Results of many studies have shown that the risk of cesarean section (CS) for both
mother and child is more than that of NVD. The World Health Organization’s (WHO) goal was to
achieve a CS rate of 15% in 2010, but this rate in most of the developing countries is over than 50%.
In this study, we try to determine the related factors influencing the method of delivery selection by
mothers in Yazd city, Iran, based on Health Belief Model (HBM). Materials and Methods: This was
a cross‑sectional study done on 130 pregnant women who presented in four clinics of Yazd. The
mothers were in 32–37 weeks of gestational age. Samples were selected by simple randomized
method. Data were collected by questionnaire by interviewing and then analyzed by analysis of
variance (ANOVA) and t‑test. Results: Mean age of samples was 42.23 ± 4.52 years. Eighty‑four
(64%) women were primigravids and 49 (37.7%) mothers were multigravids. Of them, the method
of delivery in previous pregnancy was NVD in 29 (22.3%) and CS in 20 (14.3%). In their present
pregnancy, the method of delivery was NVD in 88 (67.7%) and CS in 42 (32.3%). The Pearson
test showed a significant correlation between perceived barriers and behavior (P=0.012). Also,
there was significant relationship between perceived susceptibility and behavior (P=0.03). There
was no significant relation between other variables (perceived benefits and perceived severity).
Conclusion: Based on the results of this study, perceived susceptibility and perceived barriers
were related to behavior significantly, so we must educate mothers using HBM to influence their
behavior toward selecting NVD as their delivery method.