“Inspiring mothers’ self-entrustment to midwives.” midwives’ and mothers’ perceptions of effective communication in the maternity ward: a qualitative study

Abstract

Background

Effective communication between midwives and mothers is an essential part of positive birth outcomes. Mothers and midwives are both important for building a communication environment during childbirth. This study was conducted to explore midwives’ and mothers’ perspectives on effective communication in the maternity ward.

Methods

This study is a part of a mixed-methods study. A qualitative inductive content analysis study using in-depth interviews with 10 midwives and 11 mothers was performed in Ahvaz, southwestern Iran, between July and October 2023. The data were analyzed via inductive content analysis techniques.

Results

The qualitative content analysis identified a core concept: mothers’ self-entrustment to midwives, reflecting their growing confidence and reliance on midwives through effective communication in maternity care. This concept is underpinned by three main categories: (1) Creating a safe space; midwives ensure physical and emotional security through empathy, privacy, and non-judgmental communication; (2) Establishing spiritual oneness; a deep emotional connection fostering unity and holistic support; and (3) Building trust; rooted in midwives’ competence, honesty, and reliability. These main categories, further elaborated through eight categories, outline specific behaviors and interactions that enhance midwife-mother communication.

Conclusions

This study demonstrated that effective midwife-mother communication, achieved by ensuring a safe environment, fostering emotional connection, and demonstrating reliability, facilitates maternal self-entrustment; a process where mothers progressively develop confidence in and reliance on their midwives. These key components form a practical framework for enhancing maternity care interactions and strengthening therapeutic relationships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-025-08092-z.

Introduction

Effective communication is a shared process of exchanging information, feelings, and meanings between individuals [1]. During pregnancy and childbirth, effective communication is fundamental to providing critical medical information, emotional support, and empathy through maternity care [2]. The highly emotional nature of labor and birth makes the maternity ward a unique environment. In this sense, effective communication is essential to achieving a positive birth experience for mothers [2]. Because midwives are often the providers most involved with mothers, their approach can shape the mother’s experience [3, 4].

Studies have shown that effective communication can minimize mothers’ anxiety and create an environment of trust [5]. Mothers need to feel supported and informed during the emotional and physical challenges of labor and birth [6]. They expect continued medical education and acknowledgment of their unique circumstances and feelings [2, 6]. Mothers feel empowered when they have clear communication with midwives [7, 8]. Because information enables mothers to make informed choices about their care, they feel a sense of autonomy [6, 9].

The evidence suggests that midwives should personalize their communication style to meet the individual needs of each mother [3]. This adaptability is key to building a relationship with the mother [10]. In addition, the results of a study that described the importance of confidence in midwives reported that they feel empowered when they use effective communication strategies [11].

Nevertheless, there are barriers to effective communication in maternity wards. Many mothers feel confused during labor and birth, which can make it difficult to obtain information and lead to misunderstandings [12, 13]. It is necessary to use communication strategies in maternity care to clearly express and receive messages [3, 4]. However, effective communication is more than information sharing. It should enable mothers to actively cooperate with midwives, adhere to clinical guidelines throughout the care process, and foster mothers’ reliance on midwives for labor and birth [2, 14].

While effective communication in maternity care is widely recognized as beneficial, there remains a limited understanding of the detailed interactions and mutual perceptions between mothers and midwives that foster trust and emotional connection. Previous research has predominantly focused on clinical outcomes or one-sided perspectives, often neglecting the interpersonal and contextual factors shaping communication in maternity wards. This gap underscores the need for qualitative research to explore the experiences of both mothers and midwives, as effective communication is inherently a two-way process. A deeper understanding of their perspectives is crucial for developing tailored strategies to address real challenges in maternity care. By examining these viewpoints, this study aims to provide valuable insights to enhance communication practices, ultimately improving maternal satisfaction and quality of midwifery care. Therefore, this qualitative study was undertaken to explore midwives’ and mothers’ perspectives on effective communication in the maternity ward.

Materials and methods

Design

This study is part of a larger mixed-methods study that includes an extensive qualitative component. A qualitative approach was employed to explore midwives’ and mothers’ perspectives on effective communication in maternity wards. This methodology was selected because it allows for an in-depth examination of the experiences, perceptions, and meanings that both groups associate with communication in maternity care.

Participants

Using a purposive sampling approach, interviews were conducted with a sample of midwives and mothers in maternity wards. Midwives were eligible to participate if they worked in maternity wards, and mothers who had normal vaginal births and were in the postpartum ward were eligible to participate. Ten midwives and eleven mothers participated in the individual interviews (Table 1). Interveiwer did not know the participants.

Table 1.

Characteristics of mothers and midwives

	Variable	n (%)
Characteristics of mothers (n = 11)
Age (year)	18–25	5 (45.5)
	26–35	6 (54.5)
Level of education	High school	9 (81.8)
	University	2 (18.1)
Parity	1	4 (36.3)
	≥ 2	7 (63.6)
Characteristics of midwives (n = 10)
Age (year)	25–39	4 (40)
	40–55	6 (60)
Level of education	Undergraduate degree	5 (50)
	Postgraduate degree	5 (50)
Work position	Employed midwife	5 (50)
	Clinical instructor in midwifery	5 (50)
Professional experience (year)	1–5	3 (30)
	> 5	7 (70)

Data collection

Data were collected via face‒to-face interviews at teaching hospitals in Ahvaz, southwestern Iran, between July and October 2023. The average length of the individual interviews was 45 min. Data collection was scheduled according to when participants wanted to participate. Data collection continued until sufficient richness and depth of data were achieved to comprehensively address the research questions. The sampling strategy aimed to capture diverse perspectives. At the beginning of each interview, researcher introduced herself, the research area, and her role in the research. The first author, a PhD candidate trained in qualitative research, conducted the interviews and asked the following questions: “Explain how you experienced communication with the mother/midwife? How do you try to ensure that you communicate well? What contributes to good communication between midwives and mothers in the maternity ward? The interview continued with probing questions such as “Can you explain more …?” or " What does this mean? “.

Data analysis

The individual interviews were audio-recorded and then transcribed and analyzed verbatim. Inductive content analysis techniques as described by Kyngas 2020 were used to analyze the data [15]. MAXQDA 2020 software was used to import all the interview transcripts. Before the next interview, the first author read the transcript several times and coded the data. Throughout the coding process, the other authors were supervised. Data reduction, data grouping, and concept formation were performed following inductive content analysis. The first step was the selection of the unit of analysis and then the analysis of the content of the manifest. Researchers read data sentence by sentence, determining if each is related to research questions. We classified any sentence related to the research question as open code. To determine which codes could be grouped, the researcher then compared the similarities and differences in the content of the open codes. The open codes were then analyzed into subcategories, which were then combined into categories and a main category. The tabulated data results, starting with the quotes and ending with the main category, were given to other authors to read and share their opinions on the results. An example of the phases of the analysis is shown in Table 2.

Table 2.

An example of an interview analysis phase using a content analysis approach

Significant statements	Subcategory	Category	Main category
“The maternity care team should be coordinated and have a consistent approach. “	Same direction in the healthcare team	Healthcare team alliance	Creating a safe space

Trustworthiness

Study rigor was addressed by several methods to ensure credibility and dependability [16]. All the authors were specifically asked to provide feedback on the study results. Member checking was used to maximize the accuracy of the data. The participants were asked to explain what was not clear to the researcher. In addition, the quality of the interviews, coding, and categories was reviewed, and a consensus was reached by two research supervisors. All phases of the study were reported in detail to ensure dependability.

Results

This study explores a core concept of effective communication between mothers and midwives: inspiring mothers’ self-entrustment to midwives and three main categories: creating a safe space, establishing spiritual oneness, and building trust (Table 3).

Table 3.

Overview of the core concept, main categories, categories and subcategories of midwives’ and mothers’ perspectives on effective communication

Core Concept	Main Categories	Categories	Subcategories
Inspiring mother’s self-entrustment to midwife	Creating a safe space	Providing opportunities for mother expression	Presence at the mother’s bedside
			Seeing, hearing, and understanding the mother
			Keeping mother calm
		Providing insights for mother	Mentally preparing the mother for labor and birth
			Familiarizing the mother with the maternity ward environment
		Preserving the mother’s dignity	Respecting human values
			Protecting privacy
			Avoiding violence
			Avoiding neglect
		Healthcare team alliance	Same direction in the healthcare team
			Effective teamwork
	Establishing a spiritual oneness	Active empathy	Nonverbal compassion
			Seeing through mother’s eyes
		Emotional connection	Friendship
			Self-disclosure
	Building trust	Support	Psychological empowerment
			Appropriate physical care
			Sharing decision making
			Continuing supportive relationship
		Paying attention to the third party of communication	Effective communication with fetus and newborn
			Preserving the dignity of the fetus and newborn

Inspiring mothers’ self-entrustment to midwives

Effective communication between the mother and the midwife facilitates the mother’s entrustment to the midwife. Importantly, when a mother entrusts herself to the midwife, she does not relinquish her agency or choice. Rather, self-entrustment represents the mother’s affirmation of her own ability while simultaneously acknowledging the competence and skill of the midwife. It is a dynamic process where the mother, feeling reassured and supported, willingly places her care in the hands of a trusted professional.

Self-entrustment is based on mutual respect and partnership. It develops when a safe and caring environment is created, allowing mothers to feel both physically and emotionally protected. Establishing spiritual oneness (a sense of emotional unity) and fostering trust through the midwife’s dependability, honesty, and skill further support this process. With self-entrustment, mothers take an active role in their own care, strengthening their confidence, independence, and partnership with midwives.

Creating a safe space

According to the results, creating a safe space, both psychologically and physically, is at the heart of effective communication in maternity care. A safe space is an environment in which mothers feel safe, valued, and free to express what they are thinking, feeling, and worrying about without fear of being judged or retaliated against.

Providing opportunities for mothers’ expression

Qualitative analysis revealed that the continuous physical and emotional presence of midwives is instrumental in establishing a supportive environment that promotes maternal feelings of safety and encourages open communication. This presence allows mothers to express their birth preferences, articulate concerns, and disclose pertinent medical information. By fostering such dialogue, midwives enable mothers to engage more actively in their care, thereby enhancing their perceived autonomy and preparedness during labor. Furthermore, this dynamic cultivates trust and reinforces the mother-midwife relationship.

The midwives highlighted the significance of staying physically close to the mother throughout the entire labor process:

“We need to be with the mother, not just write notes and leave. The presence of a midwife next to the mother gives her peace and establishes a good relationship”. (Midwife #6)

Although, building trust with the mother requires more than physical presence; emotional connection is essential for true support. As one midwife expressed:

“In my opinion, in order to build a relationship, we also need to be emotionally present with the mother. Our presence should not only be for therapeutic purposes”. (Midwife #4) “.

The participants reported that providing opportunities for the mother’s expression can be achieved through active listening, which involves hearing the mother’s words and recognizing the mother’s emotions and intentions.

One midwife remarked:

“We need to give the mother more opportunities and establish a good relationship with her. Explain all her questions. For example, give the mother the opportunity to ask all her questions. The mother’s peace of mind allows her to express her concerns and uncertainties more easily”. (Midwife #6)

Providing insights for mothers

Qualitative analysis indicated that informing mothers about labor physiology and potential interventions enhances their reassurance and sense of safety. Understanding expected bodily changes and medical procedures reduces anxiety by mitigating uncertainty. This knowledge enables informed decision-making, fostering greater autonomy and engagement during childbirth.

Additionally, offering clear explanations about the birth process helped mothers feel informed and calm, lowering anxiety caused by uncertainty:

“The mother’s first need for effective communication with the midwife during labor and birth is understanding. The mother needs to understand the process of labor and birth. If the mother does not know who is her doctor, who is her midwife, all these ambiguities create fear and doubt in the mother.“. (Midwife #5)

The participants expressed that the provision of insight can be helpful in the birth process through the reduction of fear and anxiety. Midwives can prepare mothers for the unpredictable aspects of birth by explaining what is happening and what to expect.

Mothers emphasized how crucial it is to get prompt and clear information about their condition:

“The midwife should tell me the results of the vaginal exam. I am in pain, and the midwife should give me hope that something good will happen. I am worried about my situation and want to know what will happen next”. (Mother #9)

Preserving the mother’s dignity

Participants highlighted that preserving maternal dignity is essential for high-quality maternity care. Midwives uphold privacy and ensure physical and emotional comfort during labor, fostering a respectful and secure environment. By reducing unnecessary exposure and managing bystanders, they encourage mothers to communicate openly.

Respecting privacy and dignity strengthened the sense of safety. Mothers felt powerless when their privacy was not respected or their questions went unanswered, highlighting the importance of interpersonal aspects in quality care:

“For effective communication, the mother’s privacy must be respected. We should close the door or leave a gap between the mothers”. (Midwife #6).

“The midwives do not answer my questions; they do not pay attention to me, and I am worried. I have problems with breastfeeding, and I have thousands of unanswered questions”. (Mother #7)

Healthcare team alliance

Participants emphasized that interprofessional collaboration is essential for effective midwife-mother communication. A cohesive healthcare team including midwives, obstetricians, and nurses ensures consistent, clear messaging, which enhances maternal trust and reduces confusion. This teamwork also enables timely and coordinated decision-making.

Collaboration among healthcare professionals also shaped this environment. When teams worked together smoothly, delivering consistent messages and unified methods, communication with mothers improved:

“Gynecologists are a key factor in effective communication between midwives and mothers. In fact, gynecologists should collaborate with midwives, allowing the natural process of childbirth to proceed and usually performing noninvasive interventions. The care team should be coordinated and have a consistent approach”. (Midwife #6)

One midwife noted that interruptions in health care teamwork negatively affect effective communication between midwives and mothers.

“My relationship with the doctor, other staff and my colleagues affects my relationship with the mother. Like a cycle, all these relationships are interconnected. If teamwork is not effective, the relationship with the mother will also be affected”. (Midwife #2).

Establishing spiritual oneness

Qualitative analysis indicates that establishing a meaningful emotional and spiritual rapport between midwives and mothers enhances therapeutic communication. This connection, characterized by mutual empathy and psychological attunement, fosters a more supportive environment conducive to open expression of maternal concerns and expectations.

Active empathy

The participants reported that active empathy means understanding the mother’s feelings and then expressing that understanding in a supportive way. When a midwife shows compassion, an atmosphere of open communication is created, and the mother feels a positive connection to the midwife.

“We must consider the mother as a member of our family. If the mother feels that you empathize with her and understand her, a good relationship will be established”. (Midwife #1).

The participants explained that active empathy can be shown to mothers through simple actions such as guided breathing or affirmation.

“Effective communication is being with the mother, using relaxation and breathing techniques. Hold the mother’s hand and touch her. If she is sitting on the birthing ball, be next to her with your hand on her shoulder.” (Midwife #5).

Emotional connection

Participants emphasized that forming an emotional connection between midwives and mothers cultivates essential feelings of safety during childbirth. This relationship goes beyond clinical care to encompass holistic support addressing psychological and social needs. Empathetic midwifery engagement facilitates sensitive responses to individual concerns and reducing maternal anxiety.

“I try to become intimate with the mother and usually the mother relaxes and says, “I wish you could stay with me until the end of my birth. I talk to the mother, joke with her and try to establish an intimate relationship. I call her by name with her permission. " (Midwife #10).

The midwives discussed how self-disclosure of experiences can help build emotional connections and help mothers feel understood and relaxed:

“I told the mother that I had a similar experience with her during my previous birth. I described my personal experience, and the mother became very relaxed and followed the therapeutic instructions”. (Midwife #2).

Building trust

Participants identified trust as a foundational component in fostering maternal security within the midwife-mother relationship. This trust facilitates effective communication and collaborative care, encouraging mothers to share sensitive information crucial for personalized care provision. A trusting relationship promotes maternal participation in decision-making, thereby enhancing autonomy during childbirth. Participants stressed that trust-building requires consistent midwifery support and attentive fetal/newborn monitoring.

Support

The participants described supporting the mother as providing physical, emotional and psychological care during the birth process. Multidimensional support was found to strengthen the communication between mother and midwife. Physical support involved practical comfort measures and pain management, while psychosocial support included empathetic communication, anxiety reduction, and validation of maternal concerns.

Midwives stressed the need for responsive, personalized care during labor, noting that identifying a mother’s fears or distress and offering empathetic communication provides comfort and reassurance tailored to her needs:

“When a mother is worried, we should be able to find the cause of her worry and try to address her concerns according to her conditions. We should understand the reason for the mother’s crying and fear and talk to her”. (Midwife #1).

Another midwife highlights that effective communication means addressing the mother’s main concerns, especially pain management during labor, through both medical and non-medical methods to provide physical and emotional support:

“Effective communication means addressing the needs of the mother. For example, mothers in labor need support and pain relief. The mother’s main concern during labor is pain. Effective communication here is pain management with both medical and nonmedical pain relief methods”. (Midwife #5).

One participant used positive and pleasant words to help the mother feel empowered:

“I do not use the word ‘pain’ in my interaction with the mother; I use the word ‘contraction’. It is better not to use the word ‘pain. Some words have negative implications.” (Midwife #3).

Enabling mothers to take part in choosing their birth positions or activities was considered essential for building trust:

“If it is possible for the mother to get out of bed, we should allow her to come down and walk. We should not confine the mother to the bed. Let the mother choose to walk or lie down. Whatever position, the mother feels comfortable in” (Midwife #10).

Paying attention to the third party of communication

The analysis revealed the fetus/newborn as a critical third participant in midwife-mother communication. Participants identified that establishing maternal trust requires midwives to demonstrate respectful consideration for both mother and fetus/newborn. By acknowledging the fetus/newborn’s presence and intrinsic dignity, midwives create a holistic environment that validates interconnectedness of mother and child. Paying attention to the fetus/newborn enhances maternal confidence and emotional security and it aligns with ethical maternity care principles. Furthermore, participants observed that this respectful engagement fosters improved mother-infant bonding and greater care satisfaction.

Midwives highlighted that congratulating mothers and honoring the baby’s dignity are key to building the mother’s trust:

“At the time the baby is born, we should congratulate the mother. I say, “Congratulations on the birth of your child”. If we do not pay attention to the baby, the mother will be neglected. I ask about the baby’s name, I ask about the meaning of the name, and I admire it. I put the baby on the mother’s breast and say, “Do not worry and let the baby suckle on your breast. This action also affects the bond between the mother and the baby”. (Midwife #2).

The participants considered eliminating any language that might undermine the personhood of the fetus or newborn crucial. Mothers emphasized that showing disrespect to the fetus or newborn can damage their trust:

“The midwife should understand that my fetus is valuable to a family. I love my fetus, I have bought things for my baby, I have chosen a name, and I have imagined a future. She should not talk disrespectfully about my fetus. I got pregnant again after 12 years, and although she is my fourth child, I am very happy and excited”. (Mother #4)

Providing physical care to the newborn and promoting skin-to-skin contact were viewed as important parts of respectful and trustworthy care:

“The midwife should provide physical care to the newborn and establish skin-to-skin contact between the mother and baby. At no time should disrespectful jokes or remarks be made about the newborn or fetus”. (Midwife #2)

Discussion

This study revealed midwives’ and mothers’ perceptions of effective communication in the maternity ward. A central finding of this study is the concept of self-entrustment, defined as the mother’s conscious affirmation of her own capability and agency during childbirth, along with her confident reliance on the midwife’s professional competence and care. This concept represents a reciprocal trust where the mother willingly places herself in the midwife’s care and guidance while maintaining her autonomy and decision-making authority. In healthcare, self-entrustment is mainly discussed in professional education, describing how trainees gain independent decision-making by trusting their competence [17]. This concept can also explain how patients, including mothers, voluntarily place confident reliance on healthcare providers’ skills, honesty, and emotional support, forming a secure, trust-based relationship that enables shared decision-making [18]. In maternity care, this is reflected in mothers’ increasing reliance on and emotional investment in midwives’ care, actively entrusting them with their health and clinical decisions [19]. Effective communication that characterized by creating a safe space, establishing spiritual oneness, and building trust forms the essential basis for cultivating self-entrustment.

A sense of safety and peace of mind that arises when mothers entrust themselves to their midwives helps them cope with the uncertainties of childbirth [6]. Mothers’ self-entrustment in midwives increases their adherence to recommendations during labor, birth, and postpartum care, which is associated with improved health outcomes for both mothers and babies [9, 20].

Previous studies have shown that when mothers perceive midwives as caring and accessible, communication becomes more effective [7, 21]. Midwives can enhance mothers’ sense of control by actively listening to their concerns, preferences, and expectations [7, 22]. Recognizing the importance of mothers feeling heard is crucial to supporting positive mental health outcomes [6, 23]. Mothers who feel their concerns are acknowledged are less likely to develop postpartum depression, as their emotional needs are met [5, 22]. There is growing evidence linking effective communication to better outcomes, including early detection of birth complications and timely interventions that reduce maternal and neonatal risks [24, 25].

Consistent with these findings, research indicates that sharing information in a safe environment leads to greater satisfaction and positive birth experiences [8, 26]. Such positive experiences are further associated with psychological benefits for mothers [6, 8, 27, 28]. Effective communication also empowers mothers, enhancing their confidence and self-efficacy in newborn care [5, 7]. Anxiety, particularly among first-time mothers, can negatively affect both maternal and neonatal health, contributing to risks such as preterm birth and low birth weight [29]. Similar to our findings, prior studies emphasize that creating an environment where mothers feel heard, affirmed, and respected is essential for anxiety reduction [8, 13, 30].

This study highlights the necessity of establishing spiritual oneness with mothers as part of effective communication. Midwives’ ability to form a deep, intuitive connection with mothers allows them to recognize unspoken needs [8, 31]. Spiritual connection aligns with person-centered care principles, prioritizing each mother’s unique needs [7, 12, 32]. It fosters trust and safety, which are particularly important in maternity wards, where women are often emotionally vulnerable [12, 27].

Building trust emerged as a critical factor for effective communication. Trust develops through continuous, respectful interactions characterized by competent care provision [17]. A trusting relationship fosters open communication, enabling mothers to express themselves freely [12, 32]. Conversely, communication barriers such as medical jargon or limited time can undermine trust and reduce communication quality [12, 33]. An important and unique finding of this study is the recognition of the fetus and newborn as third parties in communication. Midwives assure mothers about the health of their child by attentively addressing the fetus’s and newborn’s physiological needs [5]. Demonstrating care for the fetus and newborn signals midwives’ competence, thus strengthening the trusting relationship [6]. Consistent with prior research, preserving fetal and neonatal dignity is essential to building trust between mothers and midwives [34], and respecting their dignity contributes to mothers’ sense of empowerment and control [35].

Improving effective communication in maternity wards has important implications for both research and practice. Midwifery education programs should emphasize developing communication skills [36]. Additionally, maternity wards need to foster environments that support effective dialogue between midwives and mothers. Future research could extend these qualitative findings by exploring communication across diverse birth settings and cultural contexts.

Strengths and limitations

This study has several important strengths due to its qualitative approach. First, it provides detailed insights into how both midwives and mothers perceive communication during maternity care. By including both groups’ perspectives - midwives’ professional views and mothers’ personal experiences - the study offers a complete picture of how communication actually occurs in clinical practice. This two-sided approach captures both the practical realities and emotional aspects of these interactions. Additionally, conducting interviews shortly after childbirth helped minimize recall bias, making the findings more reliable.

This study has several limitations that should be considered. First, the research was conducted only in teaching hospitals in Ahvaz, Iran, meaning the findings may not fully apply to other healthcare systems or cultural contexts. Second, while the study explored communication experiences, it did not specifically examine how factors like socio-economic background, ethnicity, or language differences might shape these interactions. Additionally, because data were collected through in-person interviews, some participants may have been hesitant to openly discuss communication difficulties due to social desirability bias. Finally, the focus on uncomplicated vaginal births means the results may not capture communication challenges in high-risk births or other maternity care scenarios. Future research could address these gaps by including more diverse settings and populations.

Conclusion

Effective communication between mothers and midwives in maternity care is a complex and multifaceted process. It involves creating a safe and supportive environment, fostering a deep emotional and spiritual connection, and establishing trust. These components facilitate therapeutic meaningful communication, enabling mothers to develop sufficient trust in midwives. Through such communication, midwives can address the holistic needs of mothers, thereby promoting a care environment that supports trust on multiple levels. This dynamic is essential for enhancing the quality of maternity care and improving maternal experiences.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

Z.Y. Designed and executed the study, coding, qualitative analysis, wrote the first draft of article. S.M. and M.J. Designed the study, coding and qualitative analysis, collaborated in editing of the final version of the manuscript. Z.A. and A.E. Commented on coding, qualitative analysis and final article. All authors reviewed the manuscript.

Funding

This study was funded by the Reproductive Health Promotion Research Center at the School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Iran.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study is part of the first author’s doctoral dissertation in midwifery. Ethical approval was obtained from the Ahvaz Jundishapur University of Medical Sciences ethics committee in Iran (IR.AJUMS.REC.1402.176) and was conducted in accordance with the principles of the Declaration of Helsinki (World Medical Association Declaration of Helsinki, 1997) and its later amendments (revised in 2013). Written informed consent was obtained from all participants. The participants were assured that the privacy and confidentiality of the information collected would be maintained at all times. The data were stored securely in password-protected and encrypted systems.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.