Maternity care priorities for prevention of psychological birth trauma in Iran: A Delphi consensus study

Background & Aim: Promoting maternal mental health is achievable through prevention of psychological birth trauma (PBT). This study aimed to investigate experts’ opinion on best strategies in prevention of PBT among childbearing women. Methods & Materials: This Delphi, systematic interactive research was conducted in Tehran, from July to November 2017. Delphi technique and policy dialogue was used to prioritize pre-defined PBT prevention strategies which had been identified in our previous studies. 13 experts were included in the Delphi. After two rounds, panelists had come to consensus on strategies’ priorities; they rated each strategy. Priority of strategies was set based on scores. Strategies with total mean of ≥9 and interquartile range (IQR) of ≤2 were entered to the next stage. At the last stage of consensus, a 4-hours meeting was held with seven policy makers; four top strategies were selected by consensus of the all members. Results: From 38 initial strategies, nine with the mean of ≥9 were identified as the top ones. At the policy dialogue meeting, four strategies were selected: continuous support during childbirth, practical childbirth preparation classes, group prenatal care, and preparing individual birth plan in antenatal visit. Conclusion: According to the experts, top four strategies can be combined in an integrated program. All these services will be provided at Primary Health Care facilities. These strategies are suggested in supporting maternity care in Iran and other developing countries to promote maternal mental and physical health.

Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions

Background

A negative experience in childbirth is associated with chronic maternal morbidities. The aim of this systematic review and meta-analysis was to identify currently available successful interventions to create a positive perception of childbirth experience which can prevent psychological birth trauma.

Methods

Randomized controlled trials of interventions in pregnancy or labour which aimed to improve childbirth experience versus usual care were identified from 1994 to September 2016. Low risk pregnant or childbearing women were chosen as the study population. PEDRO scale and Cochrane risk of bias tool were used for quality assessment. Pooled effect estimates were calculated when more than two studies had similar intervention. If it was not possible to include a study in the meta-analysis, its data were summarized narratively.

Results

After screening of 7832 titles/abstracts, 20 trials including 22,800 participants from 12 countries were included. Successful strategies to create a positive perception of childbirth experience were supporting women during birth (Risk Ratio = 1.35, 95% Confidence Interval: 1.07 to 1.71), intrapartum care with minimal intervention (Risk Ratio = 1.29, 95% Confidence Interval:1.15 to 1.45) and birth preparedness and readiness for complications (Mean Difference = 3.27, 95% Confidence Interval: 0.66 to 5.88). Most of the relaxation and pain relief strategies were not successful to create a positive birth experience (Mean Difference = − 2.64, 95% Confidence Intervention: − 6.80 to 1.52).

Conclusion

The most effective strategies to create a positive birth experience are supporting women during birth, intrapartum care with minimal intervention and birth preparedness. This study might be helpful in clinical approaches and designing future studies about prevention of the negative and traumatic birth experiences.

Electronic supplementary material

The online version of this article (10.1186/s12978-018-0511-x) contains supplementary material, which is available to authorized users.