Original Article

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


Background and 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 and 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.

1. Tunçalp Ӧ, Were W, MacLennan C, Oladapo O, Gülmezoglu A, Bahl R, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG: an international journal of obstetrics & gynaecology. 2015;122(8):1045-9.
2. World Health Organization. Strategies towards ending preventable maternal mortality (EPMM). 2015.
3. Carter MC, Corry M, Delbanco S, Foster TC-S, Friedland R, Gabel R, et al. 2020 vision for a high-quality, high-value maternity care system. Women's health issues. 2010;20(1):S7-S17.
4. Demyttenaere K, Bruffaerts R, Posada-Villa J, Vivan IG. Prevalnce, severity an unmet nee for treatment of mental isrers in the Worl Health Organization Worl Mental Health Surveys. Jama. 2004; 291(21);2581-2509.
5. Noorbala AA, Bagheri Yazi SA, Yasamy MT, Mohammad K. Mental health survey of the ault population in Iran, The british Journal of psychiatry. 2004; 184(1):70-73.
6. Modarres M, Afrasiabi S, Rahnama P, Montazeri A. Prevalence and risk factors of childbirth-related post-traumatic stress symptoms. BMC pregnancy and childbirth. 2012;12(1):88.
7. Zaers S, Waschke M, Ehlert U. Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. Journal of Psychosomatic Obstetrics & Gynecology. 2008;29(1):61-71.
8. Taheri M, Takian A, Taghizaeh Z, Jafari N, Sarafraz N. Creating a positive perception of chilbirthexperience:systematic review an meta-analysis of prenatal an intrapartum interventions. Reprouctive Health. 2018; 15(1):73-83.
9. McKenzie-McHarg K, Ayers S, Ford E, Horsch A, Jomeen J, Sawyer A, et al. Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research. Journal of Reproductive and Infant Psychology. 2015;33(3):219-37.
10. Bastos MH, Furuta M, Small R, McKenzie-McHarg K, Bick D. Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database Syst Rev. 2015; No.: CD007194. DOI: 10.1002/14651858.CD007194.pub2 (4).
11. http://www.birthtraumaassociation.org.uk/ en/, accessed 26 February 2018.
12. http://pattch.org/ en/ accessed 26 February 2018.
13. Taheri M, Taghizadeh Z, Takian A. Designing an integrated evidence based plan for prevention of psychological birth trauma in the Iran’s Health System, Tehran: Tehran University of Medical Sciences; 2017.
14. Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Information & management. 2004;42(1):15-29.
15. Takian A. Implementing family medicine in Iran: identification of facilators and obstacles: University of London, UK; 2009.
16. Promotion of the pregnant women mental health: proposal of health department. Kashan university of meical sciences. 2013 [in persian].
17. Mohammadi A, Mohammadi J. Evaluating quality of health services in health centres of Zanjan district of Iran. Indian Journal of Public Health. [SHORT COMMUNICATION]. 2012 October 1, 2012;56(4):308-13.
18. Hilbert M, Miles I, Othmer J. Foresight tools for participative policy-making in inter-governmental processes in developing countries: Lessons learned from the eLAC Policy Priorities Delphi. Technological Forecasting and Social Change. 2009;76(7):880-96.
19. Loureiro MI, Goes AR, Paim da Câmara G, Gonçalves-Pereira M, Maia T, Saboga Nunes L. Priorities for mental health promotion during pregnancy and infancy in primary health care. Global health promotion. 2009;16(1):29-38.
20. Kauye F, Jenkins R, Rahman A. Training primary health care workers in mental health and its impact on diagnoses of common mental disorders in primary care of a developing country, Malawi: a cluster-randomized controlled trial. Psychological medicine. 2014;44(3):657-66.
21. Baron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T, et al. Maternal mental health in primary care in five low-and middle-income countries: a situational analysis. BMC health services research. 2016;16(1):53.
22. Equipping 355 Helath centers with chilbirth prepration classes. https://www.borna.news/ ,accessed 13 March 2018 [in Persian].
23. Rabiepoor S, Alipoor P, Mesgarzadeh M, Shirzadeh E. The effect of childbirth preparation training classes on attitude of women towards the delivery method. The Journal of Urmia University of Medical Sciences. 2017;15(8):567-74 [in Persian].
24. Najafi F, Abouzari-Gazafroodi K, Jafarzadeh-Kenarsari F, Rahnama P, B. GC. Relationship between attendance at childbirth preparation classes and fear of childbirth and type of delivery. Hayat, Journal of School of Nursing and Midwifery, Tehran University of Medical Sciences. 2016;21(4):30-40 [in Persian].
25. Jamilian M, Mobasseri S, Wakilian K, Jamilian H. Effect of childbirth preparation classes on the duration of admission and satisfaction of mothers. Scientific Journal of Ilam University of Medical Sciences. 2013;21(2):44-50 [in Persian].
26. Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H, et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstetrics and gynecology. 2007;110(2 Pt 1):330.
27. Fabian HM, Rådestad IJ, Waldenström U. Childbirth and parenthood education classes in Sweden. Women's opinion and possible outcomes. Acta obstetricia et gynecologica Scandinavica. 2005;84(5):436-43.
28. Steel A, Frawley J, Adams J, Diezel H. Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review. Health & social care in the community. 2015;23(3):225-41.
29. Afshar Y, Wang ET, Mei J, Esakoff TF, Pisarska MD, Gregory KD. Childbirth education class and birth plans are associated with a vaginal delivery. Birth. 2017;44(1):29-34.
30. Bailey JM, Crane P, Nugent CE. Childbirth education and birth plans. Obstetrics and Gynecology Clinics. 2008;35(3):497-509.
31. Lothian J. Birth plans: the good, the bad, and the future. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2006;35(2):295-303.
32. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016; doi: 10.1002/14651858.CD004667.pub5
33. The number of Miwives per birth in country is not accrding to the world qovernor . https://www.irna.ir/news/ ,accessed 10 December 2018 [in Persian].
IssueVol 6 No 1 (2019): Winter QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v6i1.390
mental health maternal mental health mental problems strategy priority of strategies quality of care quality of maternal health care quality maternity care system

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Taghizadeh Z, Taheri M, Takian A, Jafari N. Maternity care priorities for prevention of psychological birth trauma in Iran: A Delphi consensus study. NPT. 2019;6(1):26-33.