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Table 3 Final set of recommendations for improving of childbirth experience in the Iran

From: Recommendations for improving primiparous women’s childbirth experience: results from a multiphase study in 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