Table 3.
Final set of recommendations for improving of childbirth experience in the Iran
| Statement | Consensus type | Percentage of consensus | Weighted score (%) |
|---|---|---|---|
| Recommendations for pregnancy stage | |||
| 1. Provide adequate information on labour and birth by written sources (books and the Internet) or professional health care providers during pregnancy | Completely agree | 100 | 1.47 |
| 2. Facilitate a peer support program for pregnant woman to receive information and support from women who had previous natural childbirth experiences | Completely agree | 100 | 1.47 |
| 3. Offer prenatal classes for all pregnant women | Completely agree | 100 | 1.47 |
| 4. Provide information and training on the pregnancy exercises by health care professionals | Completely agree | 90.9 | 1.44 |
| 5. Develop educational prenatal classes based on with the current care system in Iran | Completely agree | 90.9 | 1.44 |
| 6. Facilitate situations where woman can become familiar with the labour room and birth personnel (e.g. Maternity tour or orientation session) | Completely agree | 90.9 | 1.44 |
| 7. Provide Midwife-led continuity care models | Completely agree | 100 | 1.47 |
| 8. Facilitate attendance and support of the woman husband or family during pregnancy | Completely agree | 100 | 1.47 |
| 9. Facilitate identifying and consulting woman with severe fear of childbirth during pregnancy | Completely agree | 90.9 | 1.44 |
| Recommendations for labour, delivery and postpartum | |||
| 10. Respect the rights of pregnant woman (e.g. maintaining woman’s dignity, privacy, respectful care, the right to make informed choices, continuous s support and care with empathy and understanding during labour and delivery). Addressed to the care providers | Completely agree | 90.9 | 1.44 |
| 11. Avoid discriminatory behavior against woman (lack of adequate care due to sex of the fetus and favoritism). Addressed to hospital staff and birth attendants | Completely agree | 100 | 1.47 |
| 12. Establish effective communication between care providers and the woman using simple and culturally acceptable methods | Completely agree | 100 | 1.47 |
| 13. Provide appropriate proportion ratio of care provider to woman | Completely agree | 100 | 1.47 |
| 14. Up skill the birth centers’ staff | Completely agree | 90.9 | 1.44 |
| 15. Provide a quiet and comfortable rooms in the emergency, labour, delivery and postpartum rooms | Completely agree | 90.9 | 1.44 |
| 16. Provide a hygienic labour and delivery room | Completely agree | 90.9 | 1.44 |
| 17. Provide appropriate physical space of the reception, labour and delivery room with right temperature, light, size and curtain | Completely agree | 90.9 | 1.44 |
| 18. Provide the facilities with beds, toilets, baths and right equipment for fetal health monitoring | Completely agree | 90.9 | 1.44 |
| 19. Provide the maternity environment with a relaxed and safe layout by using cheerful colors, pleasant smells, proper decoration and music playback | Completely agree | 90.9 | 1.44 |
| 20. Provide appropriate and comfortable clothing for woman and personnel | Completely agree | 90.9 | 1.44 |
| 21. Provide appropriate clothing for woman to keep hijab in the hospital | Completely agree | 90.9 | 1.44 |
| 22. Facilitate the required conditions for the presence of an accompanying person (woman relative or husband) during labour and delivery | Completely agree | 81.8 | 1.40 |
| 23. Provide required conditions for the presence of doula during labour and delivery | Completely agree | 100 | 1.47 |
| 24. Provide facilities for telephone conversation for women who have no support person accompanying her during labour | Completely agree | 100 | 1.47 |
| 25. Involve women in decision makings | Completely agree | 72.7 | 1.29 |
| 26. Avoid unnecessary use of the bladder catheter during labour | Completely agree | 100 | 1.47 |
| 27. Prevent fetal or neonatal complications during labour, delivery and postpartum | Completely agree | 100 | 1.47 |
| 28. Mandate the auscultation using Doppler ultrasound device or Pinard fetal stethoscope for the assessment of fetal health on labour admission | Completely agree | 100 | 1.47 |
| 29. Limit unnecessary labour admissions, such as admitting a healthy women presenting within latent phase of labour | Completely agree | 72.7 | 1.29 |
| 30. Provide sufficient information on the definitions of the latent and active phase of labour and duration of labour | Completely agree | 72.7 | 1.29 |
| 31. Reinforce adequate information about care process or interventions in the woman’s own language | Completely agree | 100 | 1.47 |
| 32. Keep the woman informed about her condition, her fetus and baby during labour and birth | Completely agree | 72.7 | 1.29 |
| 33. Avoid unnecessary vaginal examinations to evaluate the routine active phase of labour in low-risk woman | Completely agree | 72.7 | 1.29 |
| Recommendations for first stage of labour | |||
| 34. Reassure intermittent auscultation of the fetal heart rate with either a Doppler ultrasound or Pinard fetal stethoscope for healthy women in labour” | Completely agree | 100 | 1.47 |
| 35. Facilitate providing Epidural analgesia for healthy pregnant women who request epidural pain relief during labour | Completely agree/agree | 72.7 | 1.29 |
| 36. Facilitate providing parenteral opioids, such as fentanyl, diamorphine and pethidine, for healthy pregnant women who request pain relief during labour, depending on her preferences” | Completely agree/agree | 90.9 | 1.44 |
| 37. Facilitate relaxation techniques, including progressive muscle relaxation, breathing, music, mindfulness and other techniques, for healthy pregnant women who request pain relief during labour, depending on a her preferences | Completely agree | 100 | 1.47 |
| 38. Facilitate providing manual pain relief techniques, such as massage or application of packs, for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences” | Completely agree | 100 | 1.47 |
| 38. Keep the low risk woman hydrated by offering oral fluid and food intake during labour | Completely agree | 100 | 1.47 |
| 40. Encourage women at low risk, to move and change position during labour | Completely agree | 100 | 1.47 |
| 41. Avoid routine amniotomy, early oxytocin administration, antispasmodics, and intravenous fluids | Completely agree | 88.9 | 1.41 |
| 42. “Avoid routine clinical pelvimetry on admission in labour for healthy pregnant women” | Completely agree | 100 | 1.47 |
| 43. Avoid routine cardiotocography for the assessment of fetal well-being on labour admission of healthy pregnant women presenting with spontaneous labour | Completely agree/agree | 72.7 | 1.41 |
| 44. Avoid routine perineal/ pubic shaving prior to giving vaginal birth | Completely agree | 100 | 1.47 |
| 45. Avoid performing enema for reducing the use of labour augmentation | Completely agree | 100 | 1.47 |
| 46. “Avoid routine vaginal cleaning with chlorhexidine durng larour for the purpose of preventing infections morbidities as it is not recommended” | Completely agree | 100 | 1.47 |
| Recommendations for second stage of labour | |||
| 47. Provide information on the definition and duration of the second stage of labour for women | Completely agree | 72.7 | 1.29 |
| 48. “Encourage and support women in the exclusive phase of the second stage of labour s to follow their own urge to push” | Completely agree | 90.9 | 1.44 |
| 49. Avoid manual fundal pressure during the second phase of labour | Completely agree | 100 | 1.47 |
| 50. Avoid routine use of episiotomy for women undergoing spontaneous labour | Completely agree | 90.9 | 1.44 |
| 51. Allow the woman to choose her birth position during delivery | Completely agree | 72.7 | 1.29 |
| Recommendations for third stage of labour | |||
| 52. Offer routine use of uterotonics for the prevention of postpartum haemorrhage (PPH) during the third stage of labour | Completely agree | 90.9 | 1.44 |
| 53. “Delaye umbilical cord clamping (not earlier than 1 min after birth” | Completely agree | 90.9 | 1.44 |
| 54. Provide controlled cord traction (CCT) for vaginal births (if the care provider and the parturient woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labour as important) | Completely agree/ agree | 81.8 | 1.27 |
| 55. Provide adequate anesthesia during episiotomy and its repair | Completely agree | 100 | 1.47 |
| 56. Avoid a sustained uterine massage as an intervention to prevent postpartum haemorrhage in women who have received prophylactic oxytocin | Completely agree/ agree | 63.6 | 1.10 |
| Recommendations for care of the newborn | |||
| 57. Avoid routine suctioning of the mouth and nose for neonates who start breathing on their own after birth | Completely agree | 100 | 1.47 |
| 58. Facilitate skin-to-skin contact with the mother for the Newborn who have with complications to prevent hypothermia and promote breastfeeding” | Completely agree | 100 | 1.47 |
| 59. Facilitate breastfeeding initiation in first hour after birth for all newborns stable when the mother and baby are ready, including low-birth-weight (LBW) | Completely agree | 100 | 1.47 |
| 60. Do not separate the mother and baby without any medical reason. Keep them in the same room during day and night | Completely agree | 100 | 1.47 |
| 61. Administrate 1 mg of vitamin K intramuscularly with parents’ consent | Completely agree | 100 | 1.47 |
| Recommendations for care of the mother after delivery | |||
| 62. “Assess uterine tons for early identification of uterine atony for all women” | Completely agree | 100 | 1.47 |
| 63. Routinely assess postpartum women for vaginal bleeding, uterine contraction, fundal height, temperature and heart rate (pulse) during the first 24 h starting from the first hour after birth | Completely agree | 100 | 1.47 |
| 64. Provide maternity and neonatal care at least for 24 h after an uncomplicated vaginal birth in a health care facility | Completely agree | 81.8 | 1.40 |
| 65. Avoid administrating routine antibiotic prophylaxis for women with uncomplicated vaginal birth | Completely agree | 81.8 | 1.40 |
| 66. “Avoid routine antibiotic prophylaxis for women with episiotomy” | Completely agree | 81.8 | 1.40 |
| 67. Be responsive to a woman's complications at any time of pregnancy, delivery and postpartum. Addressed to all health care providers | Completely agree | 81.8 | 1.40 |