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September 2017 -
Volume 15, Issue 7
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From the Editor

 
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In Memoriam
Professor Orhan Ekrem Müftüoglu
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Original Contribution / Clinical Investigation












 











































Cholelithiasis and cholecystectomy may lower the low density lipoprotein cholesterol in plasma
DOI:
10.5742/MEWFM.2017.93010
[pdf version]
Mehmet Rami Helvaci, Mursel Davarci, Orhan Veli Ozkan, Ersan Semerci, Abdulrazak Abyad, Lesley Pocock


Serum and follicular fluid vitamin D and follicular response among infertile women undergoing ICSI
DOI: 10.5742/MEWFM.2017.93011
[pdf version]
Sedighe Esmaeilzadeh, Maryam Aliasgharpour, Parvaneh Mirabi, Azita Ghanbarpour
Maede Fasihian

Studying the relation of quality of work life with socio-economic status and general health among the employees working in Students Welfare Fund of Ministry of Health and Medical Education in 2016
DOI: 10.5742/MEWFM.2017.93012
[pdf version]
Saeed Reza Azami, Nasrin Shaarbafchizadeh, Soheil Mokhtari, Ali Maher

On the Effect of Cognitive Behavioural Counseling on Sexual Satisfaction of Mothers with Autistic Children: A Randomized Clinical Trial
DOI:
[pdf version]
Leila Arbil, Mitra Kolivand, Farzaneh Golboni, Effat MerghatiKhoei, Mansour Rezaei

Pre-operative sublingual misoprostol and intra-operative blood loss during total abdominal hysterectomy: a randomized single-blinded controlled clinical trial
DOI: 10.5742/MEWFM.2017.93013
[pdf version]
Taravat Fakheri, Tayebe Noori

Investigating the Effect of Endotracheal Tube Cuff Pressure on Sore Throat, Hoarseness and Cough in Patients with Coronary Artery Bypass Surgery
DOI: 10.5742/MEWFM.2017.93014
[pdf version]
Ali Akbar Vaezi, Mohammad Hassan Mondegari Bamakan

Comparing the Self-Esteem and Resiliency between Blind and Sighted Children and Adolescents in Kermanshah City
DOI: 10.5742/MEWFM.2017.93015
[pdf version]
Saeedeh Bakhshi, Nafiseh Montazeri , Babak Nazari, Arash Ziapour, Hashem Barahooyi,
Fatemeh Dehghan

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Population and Community Studies

 

 

 

 

 

 

 






 

 










Frequency of Uric Acid Levels, Symptomatic and Asymptomatic Hyperuricemia among the Pakistani Population
DOI: 10.5742/MEWFM.2017.93016
[pdf version]
Waris Qidwai, Masood Jawaid

Determinants of Tooth Brushing among Primary School Students
DOI: 10.5742/MEWFM.2017.93017
[pdf version]
Mohammad Mahboubi, Mohammad Ismail Motlagh, Mehdi Mirzaei-Alavijeh, Farzad Jalilian, Hassan Gharibnavaz,
Mohammad Fattahi

Depression in patients suffering from gender dysphoria: The hospitalized patients of Legal Medicine Center in Southwest of Iran
DOI: 10.5742/MEWFM.2017.93018
[pdf version]
Zahra Gorjian, Mohammad Zarenezhad, Mohhamad Mahboubi, Saeid Gholamzadeh,
Nahid Mahmoodi

An epidemiological study of suicide attempts and to determine the correlation between attempted suicide causes and demographic characteristics of people in Kermanshah Province during a year
DOI: 10.5742/MEWFM.2017.93019
[pdf version]
Hamid Reza Shetabi, Samira Rostami, Mohsen Mohammadi, Mahsa Cheleii, Lida Saedi, Saba Amiri Nasab,
Shirin Zardui GolAnbari

The effectiveness of life skills training on happiness, mental health, and marital satisfaction in wives of Iran-Iraq war veterans
DOI: 10.5742/MEWFM.2017.93038
[pdf version]
Kamal Solati

The Role of Self-Compassion Factors in Predicting the Marital Satisfaction of Staff at Kermanshah University of Medical Sciences
DOI:10.5742/MEWFM.2017.93020
[pdf version]
Parisa Janjani, Lida Haghnazari, Farahnaz Keshavarzi, Alireza Rai

Mediating role of irrational beliefs in the relationship between the quality of family communication and marital satisfaction
DOI:10.5742/MEWFM.2017.93021
[pdf version]
Parisa Janjani, Khodamorad Momeni, Alireza Rai, Mohammad Reza Saidi

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Review Article



New Methods in Treatment of Renal failure in Patients with Multiple Myeloma: A Review with Immunological Approach
DOI: 10.5742/MEWFM.2017.93022
[pdf version]
Ali Saeedi-Boroujeni, Sara Iranparast, Majid Shirani

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International Health Affairs



Congenital anomalies: Overview and a brief report on promising new research
DOI: 10.5742/MEWFM.2017.93023
[pdf version]
Lesley Pocock, Mohsen Rezaeian, Majid Asadi-Samani, Alireza Seidavi, Mansour Nazari Chafjiri

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Education and Training































Investigating the Use of Smartphones for Learning Purposes by Iranian Dental Students
DOI: 10.5742/MEWFM.2017.93024
[pdf version]
Mohammad Shooriabi, Abdolreza Gilavand

The Effect of Educational Training on Nurses' Clinical Function of Cardiopulmonary Resuscitation
DOI: 10.5742/MEWFM.2017.93025
[pdf version]
Makieh Jokari, Zahra Gorjian

Comparison of the attitude toward stigma among the staff and students and faculty at Abadan School of Medical Sciences
DOI: 10.5742/MEWFM.2017.93026
[pdf version]
Mohammad Mahboobi, Saeid Gholamzadeh, Mohammad Zarenezhad, Zeynab Namadmaliani Zadeh, Nahid Mahmoodi

The effectiveness of sexual skills training with a cognitive-behavioral approach on sexual dysfunction among infertile women
DOI: 10.5742/MEWFM.2017.93038
[pdf version]
Nasrin Jalilian, Zahra Mokari

How to prepare a poster for a scientific presentation
DOI: 10.5742/MEWFM.2017.93027
[pdf version]
Maryam Rezaeian, Mahsa Rezaeian, Mohsen Rezaeian

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Clinical Research and Methods









































Adaptive LASSO Logistic Regression applied on gene expression of prostate cancer
DOI: 10.5742/MEWFM.2017.93028
[pdf version]
Amir Hossein Hashemian, Maryam Ghobadi Asl, Soodeh Shahsavari, Mansour Rezaei,
Hadi Raeisi Shahraki

The prevalence of brain and neck injuries in patients with maxillofacial fractures in teaching hospitals of Rasht in 2016
DOI: 10.5742/MEWFM.2017.93029
[pdf version]
Seyed Mohammad Talebzadeh, Ali Khalighi Sigaroudi, Babak Alijani, Safa Motevasseli,
Saied Dashtyari, Mahsa Shariati, Zeinab Davoudmanesh

Cultural competency: a concept analysis in TUMS (Tehran University of Medical Science) DOI: 10.5742/MEWFM.2017.93030
[pdf version]
Foruzan Khatamidoost, Mandana Shirazy, Hamid Khankeh, Nemat Allah Musapour
Majid Sadeghi, Kamran Soltani Arabshahi

The Effect of Proprioceptive Neuromuscular Facilitation (PNF) on Activities of Daily Living of client with Cerebrovascular accident
DOI: 10.5742/MEWFM.2017.93031
[pdf version]
Najafi Doulatabad Shahla, Afrasiabifar Ardashir, Parandvar Yaghoub

Evaluation of the ratio of T helper 17 and T regulatory cells in patients with chronic idiopathic urticaria
DOI: 10.5742/MEWFM.2017.93032
[pdf version]
Hossein Shahriari, Farahzad Jabbari, Seyyed Abdolrahim Rezaee, Houshang Rafatpanah
Majid Jafari, Reza Farid Hosseini, Majid Asadi-Samani

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Model and System of Primary Care




The Effect of Health System Development Plan on Reduction of First Cesarean in Kohgiluyeh and Boyer Ahmad in 2016
DOI: 10.5742/MEWFM.2017.93033
[pdf version]
Hajar Shokoohi Asl, Parviz Aghaei Barzabad, Abbas Yazdanpanah

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Case Series and Case Reports








<<Iran>>
Carbamazepine-induced toxic epidermal necrolysis treated with intravenous immunoglobulin and amniotic membrane: A case report
DOI: 10.5742/MEWFM.2017.93035
[pdf version]
Mohammadreza Mobayen, Abbas Darjani, Roghayeh Aghebati , Ramyar Farzan

<<Iran>>
Right Thoracotomy Beating Heart Technique in Emergency Re-Do Mitral Valve Surgery: Is it Still Justified?
DOI: 10.5742/MEWFM.2017.93034
[pdf version]
Hassan Mir Mohammad Sadeghi


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September 2017 - Volume 15, Issue 7

The Effect of Health System Development Plan on Reduction of First Cesarean in Kohgiluyeh and Boyer Ahmad in 2016

Hajar Shokoohi Asl (1)
Parviz Aghaei Barzabad
(2)
Abbas Yazdanpanah
(3)

Hajar Shokoohi Asl (1)Parviz Aghaei Barzabad (2)Abbas Yazdanpanah (3)
(1) Assistant Professor, Department Of Medical Education Management , Social Determinant of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
(2) Assistant Professor. Department of Healthcare Management. Marvdasht Branch, Islamic Azad University. Marvdasht, Iran
(3) MA Students, Department of Healthcare Management. Marvdasht Branch, Islamic Azad University. Marvdasht. Iran

Correspondence:
Parviz Aghaei Barzabad
Assistant Professor, Department of Healthcare Management,
Marvdasht Branch,Islamic Azad University,
Marvdasht, Iran

Abstract


Preserving health and promoting it is one of the transcendental goals of health systems of countries which is being scrutinized every day by utilizing financial, human, and modern methods. Cesarean delivery in all countries is one of the indicators for evaluating the performance of health programs (Nematzadeh, 2015). Considering the known complications of cesarean delivery and the growing trend of this practice in Iran, for the purpose of preserving and promoting the health of mothers and babies and improving the conditions of delivery, promoting normal delivery is one of the guidelines for the development of the health system (Farzighi et al., 2015). The aim of this study was to measure the success of this project in decreasing first cesarean delivery in Kohgiluyeh and Boyerahmad province in 2016.

Materials and Methods: In this study, the database of hospitals was used to collect data. Separate data related to the causes of cesarean section were introduced from the hospitals’ delivery offices to the Excel form and then statistical methods were used to analyze the data. In the first step, using descriptive statistics methods including mean, standard deviation, the minimum and maximum values and plotting the tables and the percentages as graphs and charts. We describe the information gathered. Then, using inferential statistical methods including independent t-test and one way and two-way analysis of variance analysis, we analyze the information. It should be noted that the SPSS software version 24 and Excel 2010 were used to analyze the data of this research.

Findings: The findings indicate that the percentage of cesarean section decreased after the implementation of the health system reform plan. Regarding the equality of variances (F = 0.39, p = 0.53 <0.05), the value of the T 2.3 was statistically significant (p <0.05). Therefore, the hypothesis of equality of meanings before and after implementation of the plan is rejected at a significant level of 5%. In other words, the percentage of cesarean section had a significant change at the 5% level after the implementation of the health system reform plan.

Conclusion: In summary, according to the findings of this research and the analysis of the other studies, one can conclude the implementation of the health system reform plan is effective in reducing cesarean section in the province and can be hoped that by continuation of this plan and implementation of all its related items to the global standard and the ultimate goal of the Ministry of Health and in principle to reduce mortality and increase the health of mothers and babies has increased in this area.

Key words: Caesarean, Natural delivery, Health system development plan,
Painless delivery


INTRODUCTION

Reforming the health system in other countries is done in different ways, but at the same time, with common goals. In Iran, one of these reforms is the implementation of the Health System Development Plan (Nematbakhsh, 2015). Considering the announcement of general health policies, the plan for the development of the health system from 2014, the approach to protecting people from the financial system, creating equity in access to health services and improving the quality of services, the health service package was officially implemented in all medical universities affiliated with the Ministry of Health and Medical Education in order to provide, maintain and promote the health of mothers and babies and improve the conditions of delivery; the promotion of normal delivery was included in the guidelines for the development plan. In the health system’s development plan, the program for the promotion of normal labor has four distinct goals: first, cesarean section cessation, second, increased satisfaction of pregnant mothers, third, the reduction in payout from the people’s pocket and fourthly increase in incentives for service providers (Farzgi et al., 2015). The process of delivery due to the importance of maternal and fetus health, the involvement of different levels of service delivery, high rates of cesarean delivery are among the most important considerations in medical science studies in the world (Lamee et al., 2014). The increasing rate of cesarean delivery is one of the problems of the health system of all societies, and Iran is no exception (Amiri Farahani and Abbasi, 2012). Certainly caesarean section is essential as a way of protecting the mother and baby’s life during difficult labor (Ghasemi, 2009). But according to the World Health Organization, a maximum of 15 percent can be acceptable (John Babaie et al., 2015). While the incidence of cesarean delivery in many countries is more than this, as cesarean section has grown from 5% to 25% in the last 20 years, in our country, in recent years, cesarean rates have increased significantly in public and private centers, so that after three countries, Brazil, Cyprus, Colombia, Iran was the fourth largest in terms of cesarean section rate, and was 46 percent in 2014 (Zahedi et al., 2015). Normal delivery is a physiological phenomenon without need for intervention (Abbaspour et al, 2014). It is a natural condition in humans as well as animals; caesarian is a medical intervention (Sorani et al., 2016). Compared with cesarean delivery, natural birth has many benefits, including reducing maternal and infant mortality, it is cost effective, lactation of these mothers is faster and better, the emotional relationship between the mother and the baby will be faster in natural delivery, which makes these babies less susceptible to respiratory problems. Resuming sexual activity is faster in these mothers and most importantly, research has shown that mothers with normal living have a better quality of life (Shams et al., 2016).

Instead, cesarean section has many problems and complications for the mother and the baby. Some of these complications include post-operative infections, bleeding, thromboembolism, re-admission within 60 days after cesarean section (Hajian et al., 2010). Pelvic damage is due to surgery, blood transfusion, pathogenicity may be exacerbated by rupture of the uterus, hysterectomy and adhesions (Yarandi et al., 2002). Post-caesium adhesions cause abdominal pain, pain in the vicinity of the stomach and pelvic pain (Sekhava et al., 2007), and an important complication that leads to intestinal obstruction, infertility and clinical problems in subsequent surgical procedures (Dehghani Firoozabadi et al., 2015). The risk of maternal death in cesarean delivery is eight times that of normal delivery (Schuitemake et al, 1997). And the complications of the wound are up to 2.5-5% higher (Basha et al, 2010). In women with a history of cesarean section, the incidence of placentaemia is 10 times higher than that of women whose previous delivery was normal, causing uncontrollable bleeding in 40-40% of these women (Jurkovic et al, 2003). Research has also shown that elective cesarean section has a negative effect on the physiological response of the infant such as increased lung volume, pulmonary arterial resistance; biochemical responses and acute respiratory syndrome increase the risk of regeneration in newborns (Pouragal et al., 2009). However, midwifery interventions from administration of sedative medicines to the creation and intensification of contractions during labor and delivery can have significant effects on the perinatal outcomes and in some cases lead the mother to the cesarean section. Therefore, physiological delivery and reduction of midwifery interventions can reduce cesarean delivery (Bolandhemat et al., 2011). Maternal stress and anxiety can be reduced by promoting natural delivery and delivery of painless medication, drug analgesics such as epidural, spinal, and gazentonox, and topical analgesics such as massage, hot water bags, and air fresheners, and music therapy (Abbasi et al., 2005). Several researchers have shown that a significant reduction in the number of cesarean sections can be made without increasing the number of pathogens. The plans presented to reduce unnecessary cesarean section generally focused on educational efforts and careful examination, normal delivery after one cesarean section, limiting cesarean section due to dystocia (Ranaei, 2004). Normal delivery in mothers who once had a cesarean section is safe and acceptable (Michael et al, 1996). Participating in childbirth classes is evident in reducing the fear of giving birth and increasing normal delivery in nursing women attending these classes (Abuzari Gozafroudi et al., 2015). Lack of knowledge and mothers anxiety increase medical interventions, especially cesarean section (Firozbakht et al., 2013).

The purpose of this study was to investigate the effect of health system reform on reducing cesarean section in Kohgiluyeh and Boyer Ahmad provinces. The probable results of this study can affect the current process of affairs and planning to reduce the total cesarean section in the province.

METHODOLOGY

In this study, the database of hospitals was used to collect data. Separate data related to the causes of cesarean section were introduced from the hospitals’ delivery offices to the Excel form and then statistical methods were used to analyze the data. In the first step, we describe the information using descriptive statistics methods, which includes average, standard deviation, minimum and maximum amounts, and plotting the charts and graphs. Then, using inferential statistics including independent t test and one way and two-way analysis of variance analysis, we analyze the information. SPSS software version 24 and Excel 2010 was used to analyze the data of this research. The current research is descriptive analytical and in terms of applied purpose. This study was conducted longitudinally in the year 2016 on the information collected about the deliveries before and after the development of the health system in hospitals affiliated with Yasouj University of Medical Sciences. In this regard, comparing the statistics of year 1992 as the base year, one year before implementation of the health care reform plan with the data of 1993, 1994 and 1995, was performed three years after the implementation of the health system reform plan. Also, training was completed for the completion of the form to the delivery staff. The statistical population includes all pregnant women who were referred to hospitals with delivery blocks in Kohgiluyeh and Boyerahmad provinces (university hospitals including Imam Sajjad (AS), Shahid Rajai, Imam Khomeini (RA) and non-university hospitals including Besat, Gomnam Shohada and Zagros) and were first cesarean deliveries. These statistics were compared. The sample is the same as the statistical population. Also, the moral rights of the university were reserved.

RESEARCH FINDINGS

In Table 1, the descriptive information related to the percentage of cesareans is reported for the first time in the entire province. On average, the percentage of cesarean deliveries was 37.44 before the implementation of the health promotion plan and after running it, it was 28.75. The dispersion of data is based on standard deviations and the lowest and maximum values are approximately the same.

In Table 2, descriptive information regarding the percentage of cesarean sections among the university centers is reported.

On average, the percentage of cesarean delivery is 29.59 before the implementation of the Health Promotion Plan, and after the implementation of it are 29.20. The dispersion of data is based on standard deviations and the lowest and the most different values and dispersion of information for the percentage of cesareans is more common among university centers before implementing a health promotion plan and this should be taken into consideration when using the test.

In Table 3, descriptive information about the percentage of cesarean sections among non-university centers is reported. On average, the percentage of cesarean delivery is 43.93 before the implementation of the Health Promotion Plan, and after it is 37.20. The dispersion of data is based on standard deviations and the lowest and maximum values are approximately the same.

According to Table 4, independent T-test data for the first cesarean were reported after the implementation of the Health Promotion Plan. Considering the equality of variances (F = 0.39, p = 0.53 <0.05), the value of the T 2.3 was statistically significant, which was significant based on p-value of 0.00 (> 0.05). Therefore, the hypothesis of equality of means before and after. On the other hand, the percentage of cesarean sections had a significant change in the level of 5% after the implementation of the health system reform plan. As shown in the table; an average of 8% was counted for the first cesarean.

According to Table 5, independent t-test data for the percentage of cesarean section at university centers before and after implementation of the health promotion plan are presented. Due to the lack of equality of variances (F = 44.73, p = 0.00), the t-test was found to be 29.5, which is significant based on the p-value of 0.00. Therefore, the hypothesis of equality of meanings after project implementation is rejected at a significant level of 5%. In other words, the percentage of cesarean section in the university centers has changed significantly at 5% level. As shown in the table, an average of 9.26% of the cesarean sections has been reduced for the first time.

According to Table 6, independent T-test data for the percentage of first cesarean in non-university centers before and after implementation of the health promotion plan have been presented. Considering the equality of variances (F = 1.40, p = 0.24), the value of T 45.1 was obtained, which is not significant at the p-value of 0.15, and so the hypothesis of equality of meanings after the implementation of the plan is not rejected at a significant level of 5%; In other words, the percentage of first cesarean has not changed in the non-university centers since the implementation of the health promotion plan. As shown in the table, an average of 6.72% of the first cesarean was decreased, but this decline is not statistically significant.









DISCUSSION AND CONCLUSIONS

In order to provide, maintain and promote the health of mothers and infants and to improve the conditions of delivery, promotion of normal delivery was included in the guidelines for the development plan and implementation of this plan has provided satisfaction to all segments of society (Farzighi et al., 2015). Childbirth can be considered one of the most beautiful events in women’s lives (the acquisition of motherhood) and at the same time a tense reality. Sometimes it is difficult to prevent the risk of a mother or newborn baby and so delivery of cesarean section can be done as a lifesaver (Zahedi et al., 2015). But in many cases, cesarean is not due to medical necessity, but the unwillingness of women to give birth in a natural way (Aghayee et al., 2015). Attitudes, behaviors and misconceptions (Badie Aval et al., 2011) and social and economic factors determine the type of delivery (Delaram and Vardis, 1997). Fear of the inability of normal delivery and associated pain (Yvonne et al, 2016) and reducing pelvic floor injury are factors (Alderdic et al, 2003). And choosing cesarean as a way for physicians and family to set their work and life plans is another reason for more women choosing cesarean section (Khani and Shabankani, 2004). To reduce non-emergency cesareans, it is necessary to delay early admission of primipara women in latent phase and the most common cause of their cesarean section is fetal distress, until the patient has entered the active phase of the delivery, unless there is indication for admission (Rahnama, 2005).

Different non-pharmaceutical methods may also be used to induce labor (Aghamohamadi et al., 2014). Instead of using oxytocin, it is possible to use other methods such as catheter to prepare the cervix and terminate the pregnancy in pregnant women, which is effective and safe and has a more favorable delivery outcome and it somewhat reduces surgical interventions (Malekzadegan et al., 2008). There are other ways to reduce cesarean delivery, including the continuous presence of midwife at the mother’s bedside and providing effective emotional and physical support during delivery (Muslim Abadi Farahani et al., 2006). Participating in childbirth classes is evident in reducing the fear of giving birth and increasing normal delivery in nursing women attending these classes (Abuzari Gozafroudi et al., 2015). Delivery in water due to reduced labor length and reduced pain and decreased need for medical interventions can be a suitable substitute for selective cesarean section (Akbari et al., 2008) and the use of pain relief methods, especially non-prescription pain relief methods that are less costly and have less side effects, can promote normal delivery and make the beautiful birth process a memorable one for the mother (Rahmanian, 191).

Seidali and Namazi, in a descriptive study in the Shoosh hospital of Khuzestan, in 1993, concluded that implementation of health system development plan was effective in reducing cesarean section and cesarean section indications. The results of this study are consistent with the present study. Aghaei et al., in a descriptive analytic study in Shiraz in 2015, concluded that the implementation of the health system development plan has led to an increase in the normal delivery rate and reduction of cesarean section in hospitals affiliated to Shiraz University, which is consistent with the findings of this study.

Surani et al (2016) in his cross-sectional descriptive study in Shahrekord concluded that implementation of health system development plan was effective in decreasing cesarean section in the first year of the project. The results of this research are also consistent with our research results.

Piroozi et al (2015) in his retrospective descriptive, longitudinal, and retrospective study, in Kurdistan Province concluded that the plan for the development of the health system to its predetermined goal, namely, a 10% decrease in the rate of cesarean section within a year after the implementation of the development plan relative to the amount was founded.

According to Table 4, there is a significant relationship between reductions of cesarean section after implementation of the development plan at a 5% level. That is, the development plan of the health system has reduced caesarean section in the province. In Table 4, there is a significant relationship between reducing the percentage of cesarean section after the implementation of the health system development plan in the provincial universities. The implementation of the health system reform plan in this province has been able to reduce cesarean section at university centers. And in Table 5, there is no significant relationship between decreasing the percentage of cesarean section after the implementation of the health system development plan in the non-university centers of this province. Despite the fact that implementation of the health system reform plan in this province has been able to reduce first cesarean at non-university centers but because the average three years after the implementation of the plan was taken into account, the total number of hospitals in the first and second year did not drop significantly and declined more in the third year than the independent T-test. This decline is not statistically significant. Educational planning can be useful for empowering physicians and midwives, performing painless and pain-free deliveries, and holding maternity-benefit classes at these centers. Taken together, according to the findings of this research, it can be concluded that the implementation of the health system reform plan (freeing from normal delivery, starting without pain, starting classes for childbirth, empowering and increasing motivation in service providers, protecting privacy and giving credit to pregnant women, and using incentive and hinting methods) is effective in reducing the caesarean rate of this province and it can be hoped that with the continuation of this plan and the full implementation of all related issues, the global standard has essentially reduced mortality and increased maternal and neonatal health.

PRACTICAL SUGGESTION S

cesarean section in this province after the implementation of the health system development plan has decreased significantly at 5% with the implementation of the following suggestions, it is possible to expect a decrease in the cesarean section in the province.

- The prevalence of physiological delivery, including maternal limitations in the mother’s bed and positions, uncontrolled attachment of serum, the use of birth balls, techniques and exercises that the mother saw when attending childbirth classes.
- Reducing childbirth interventions, including induction and strengthening of labor, episiotomy will reduce the fetal distress and related cesarean section.
- Training personnel in the beliefs of the physiological delivery and their empowerment. Certainly, the implementation of all items related to the guidelines for the promotion of normal delivery will lessen cesarean delivery in this province. In this regard, our proposal is as follows:
- Timely payment of staff remuneration to motivate employees.
- The development of maternity unit blocks with single-room rooms for the mother, which will satisfy the mothers.
- A companion to the mother who encourages and reduces stress for the mother.
- Permission of delivery by the mother or a privately appointed obstetrician or midwife. Not only the development of painless labor pain but also the use of non-prescription pain relief methods such as aromatherapy, music therapies, massage, hot water bin, etc.
- Respect for the mother.
- Provide retraining courses for midwives responsible for holding childbirth classes.

It seems that lack of awareness of families is the reason for the high incidence of cesarean section therefore, it is suggested that the localization of codes and culture-building be more influential according to the native beliefs of each region, including the holding of festivals for the promotion of normal delivery, lectures, meetings with women and their families, film and media production in accordance with beliefs.

Acknowledgments:
Thank you for the efforts of my dear Dr. Parviz Aghaei, the professor of guidance and Mr. Abbas Yazdanpanah, the director of the group and my esteemed advisor, I sincerely thank Mrs. Goodarzi, my valuable colleague, who has helped and guided me in all the stages of this research and has provided the necessary advice.

REFERENCES

Abuzari Ghazafroodi, Kobra et al. (2005). Relation of participation in childbirth preparation classes with fear and type of delivery. Journal of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, 21, 40-30
Amiri Farahani, Leila. Abbasi, Jalal (2012). Study of the process of changes in cesarean section in Iran. Journal of Fasa University of Medical Sciences, 127,3
Aghai, Parviz et al. (2015). The Effect of Health System Development on the Rate of Natural Delivery and Cesarean Delivery in Shiraz University of Medical Sciences, 2015. Final Booklet of the National Congress on Health Management, First National Congress on Health Management Sciences Graduates, Tabriz, Iran, vol. 95, p. 151
Aghamohammadi, Masoumeh et al (2014). Effect of castor oil on the onset of labor pain. Journal of Urmia Nursing and Midwifery Faculty, 12, 353-34
Badiy Aval, Shapur et al. (2013). Evaluation of cesarean delivery and its causes in hospitals affiliated to Mashhad University of Medical Sciences. Women - Obstetrics and Infertility, 66, 17-10.
Boland Hemat, Maryam et al. (1390). Relation of the usual midwifery interventions during labor with the amount of ganglia of the umbilical cord, Journal of North Khorasan University of Medical Sciences, 2, 1
Pourajjal- Jalal et al. (2005). Promoting safe delivery by educating health workers and pregnant mothers with the goal of reducing cesarean delivery in Malayer. Scientific Journal of the Medical Council of the Islamic Republic of Iran, 2, 153-149
Piroozi, Bakhtiar et al. (2015). The effect of health system development plan on cesarean section and average cost paid by mothers. Journal of Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, 3, 254-245
John Babaie, Qassim et al. (2015). Evaluation of cesarean delivery and normal delivery in Mazandaran hospitals from 1346 2014 and its prediction till 1400. Journal of Mazandaran University of Medical Sciences, 134, 11-1
Hajian, Sepideh et al. (2010). Views of pregnant mothers, midwives, women and midwifery and anesthesiologists about delivery method. Peas Quarterly, 1, 48-39
Khani, Soghra Shabankhani, Bijan (2004). Can cesarean section be reduced in Mazandaran province? Journal of Mazandaran University of Medical Sciences, 14, 81-13
Dehghani Firoozabadi, Razieh et al. (2015). The study of adhesion due to cesarean delivery and its related maternal and neonatal outcomes in patients referred to Shahid Sadoughi Hospital in Yazd. Journal of Shahid Sadoughi University of Medical Sciences, Yazd, 1, 1782-1776
Delarm, Masoomeh Doris, Fatima (1997). Examination of maternal and fetal causes of cesarean delivery in Chaharmahal and Bakhtiari province. Journal of Shahrekord University of Medical Sciences, 4, 53-49
Rahmanian, Seideh Adleh et al (2012). Aromatherapy and its beneficial effects on safe natural delivery. Summary of Articles of the First National Conference on Applied Research in Public Health and Sustainable Development, 428
Rahnama, Parvin et al. (2005). The relationship between first-born women in the active and latent stages of delivery with cesarean section and Caesarean section. Journal of Tehran University of Medical Sciences, 63, 985-980
Ranaee, Fariba (2004). Frequency of Cesarean Selection Causes in Mothers Referring to Besat Hospital in Sanandaj. Journal of Kermanshah University of Medical Sciences, 534, 1301
Zahedi, Maryam et al. (2015). Attention to the role of medical assistants in decreasing cesarean section design and psychometric evaluation of attitude assistants’ questionnaire regarding selective cesarean section and vaginal delivery. Iranian Journal of Ethics and Medical History, 4, 71-58
Sekhavat, Lily et al (2007). Investigating the effect of sewing and peritonectomy in previous cesarean section on the adhesion created in the second cesarean section. Kosar Medical Journal, 2, 179-175.
Sorani, Mahin Dukht et al (2016). Impact of the implementation of the guidelines on the promotion of normal delivery of the health system reform program on normal delivery and cesarean section in pregnant women referred to Hajar hospital in Shahrekord. Booklet of the National Congress of Health Management First National Congress of Health Sciences Management Graduates Tabriz, 95, p. 190
Shams, Mohsen et al. (2016). Designing a special intervention to promote natal labor in prenatal pregnant women. Journal of Obstetrics, Gynecology and Infertility, 30, 9-25
Sidali, Ashraf. Namazi, Navid. (2015). Consideration of changes in cesarean indices before and after implementation of health care reform plan in pregnant women referring to Masoumeh hospital in Shoush province, Khuzestan province. Pajhwandeh Magazine, 6, 319-315
Abbaspour, Zahra et al. (2014). Women of childbirth and its impact on the choice of delivery method. Journal of Tehran University of Medical Sciences Research Center, 5, 587-575.
Abbasi, Z et al. (2007). The effect of massage on physiological indices of prenatal mothers. Afgh Danesh Journal of Gonabad University of Medical Sciences and Health Services, 13, 1
Firouz Bakht, Mojgan et al. (2013). The effect of prenatal education classes on the process of delivery. Faculty of Medical Sciences, Islamic Azad University, Kasari, 2, 55-48
Ghasemi, Fatemeh (2012). Frequency and Causes of Cesarean in Yazd Province. Journal of Shahid Sadoughi University of Medical Sciences, Yazd, 2, 236-229
Lamie, Abu al-Fattah et al. (2013). Effect of experimental design of natural clinical course on reducing unnecessary interventions in labor in Imam Reza Hospital, Urmia. Journal of Urmia Nursing and Midwifery Faculty, 2, 146-138
Muslim Abadi Farahani, Sholeh et al. (2006). The effect of prophylactic care during labor on type of delivery. Journal of Nursing, 18, 82-71
Malekzadegan, Aqdas et al. (2008). Comparison of the results of using catheter and sentosinone in cervical preparation and delivery implications. Iranian Journal of Nursing, 21, 15-7
Nematbakhsh, Mehdi (2015). Research in the Health System Development Plan. Iranian Journal of Educational Sciences in Nursing Sciences, 11, 66-64
Yarandi et al, F (2002). Evaluation of knowledge and attitude of pregnant women about delivery methods in patients referring to health centers in Tehran. Journal of Guilan University of Medical Sciences, 42, 20-15
Alderdice F, Mckenna D, Dornan J.(2003). Techniques and materials for skin closure in cesarean section. Cochrane Database Syst Rev2003;(2):CD003577.
Basha SL. et al (2010). Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. AM J Obstet Gynecol 2010;203(3):285.e1-8.
Jurkovic D. et al.(2003). First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Obstetrics and Gynecology, 3,220-227.
Michael MD.et al.(1984). Active management of labor as an alternative to cesarean section for dystocia. Obstetrics and gynecology,25,268-270.
Schuitemake N. et al. (1997). Maternal mortality after cesarean section in the Netherlands. Acta Obstet Gyecol Scand 1997 Apr;76(4):332-4.
Yvonne,L.et al.(2016). Association between child birth attitudes and fear on birth preferences of a future generation of Australian parents. Women and Birth Gmodel Wombi,532,7.

 

 

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