Journal of Midwifery & Reproductive health
Volume:6 Issue: 2, Apr 2018

Early breastfeeding initiation (EBFI) defined as giving breast milk within the first hours following birth, which is recommended as a simple strategy for the enhancement of neonatal health and survival. This descriptive qualitative study was conducted to explore the practices, perceptions and beliefs of renowned traditional birth attendants (TBA) regarding EBFI in Chipinge rural community, Zimbabwe.
The study population was selected through purposive sampling technique. One-on-one interview was conducted for the purpose of unearthing sensitive issues regarding EBFI. The data were collected using an unstructured in-depth interview to explore the practices, perceptions, and beliefs regarding EBFI. Data analysis was carried out using thematic analysis. To this end, the data were presented in thematic categories using the deductive approach and coded into subthemes, which were then merged into themes. The trustworthiness of the study was enhanced through credibility, dependability, confirmability and transferability.
The emerged themes included EBFI preparation, EBFI and significance of colostrum, and determinants of EBFI. The findings revealed that EBFI was not only related to physical and emotional interactions, but also associated with a totality of the person, involving sociocultural ties. The EBFI is viewed as a predictor of maternal sociocultural integrity and the legitimacy of the newborn. In the context under study, failure to breastfeed or to initiate breastfeeding early is thought to be a result of the mother’s past immorality. Breastfeeding in Chipinge community goes beyond the mother-baby interaction.
It encompasses the whole person, that is the physical, social, cultural and spiritual ties. Under this condition, the mother should testify and undergo a ritual cleansing to rectify the problem.

Adverse childbirth experiences can lead to the emergence of mental disorders, such as acute stress disorder (ASD), in mothers in the postpartum period. Birth trauma can occur following aggressive procedures such as emergency cesarean section. This study aimed to determine the effect of supportive counseling intervention on the symptoms of ASD in women after emergency cesarean delivery.
This randomized clinical trial was conducted on 126 women with traumatic emergency cesarean section at Payambar-E Azam and Afzalipoor hospitals in Kerman, Iran. The participants were selected based on DSM-IV criteria. The subjects were randomly divided into the intervention and control groups. The intervention group received individual and face-to-face supportive counseling. The data collection tool was the Acute Stress Disorder Questionnaire, which was completed one and three weeks post-intervention. The data were analyzed using descriptive and inferential statistics by SPSS, version 13.
The two groups were comparable in terms of demographic characteristics, pregnancy complications, and midwifery history. Also, there was no significant difference between two groups regarding the depression and anxiety mean scores at the pre-intervention stage. The results revealed a statistically significant difference between the control and intervention groups in terms of all acute stress disorder symptoms after one and three weeks of the intervention (P As the findings indicated, the provision of supportive counseling for the mothers with a traumatic emergency cesarean section had a significant impact on the reduction of ASD symptoms.

Physiological changes during pregnancy cause high levels of stress in the mother. Thus, the need for maternal psychological adjustment using coping strategies is important. Coping strategies can be influenced by individual beliefs and attitudes. Therefore, this study was performed to determine the relationship between irrational beliefs and prenatal coping strategies.
This descriptive correlational study was conducted on 702 low-risk pregnant women at 35-39 weeks of gestation (gravidity: 3≥) who referred to the health centers of Mashhad, Iran, during 2015. Multi-stage random sampling was used to select the participants (stratified, cluster proportional to size). Data collection tools included Demographic and Midwifery questionnaire, Irrational Beliefs Test, and Revised Prenatal Coping Inventory. Reliability of the scales was determined with inter-class correlation coefficient. Data were analyzed using descriptive statistics, Spearman correlation, regression, and general linear models by SPSS, version 16.
Total score of irrational beliefs had a significant direct correlation with avoidance coping strategies (r=0.24, P0.05). Also, types of irrational beliefs were significantly related to the dimensions of perinatal coping strategies (P Considering that types of irrational beliefs can affect stress coping behaviors, it is necessary to include the evaluation of these two issues in prenatal screening.

To have successful pregnancy, it is necessary to focus on the mother’s quality of life during pregnancy. This study was conducted to determine the predictors of quality of life among Iranian pregnant women.

This cross-sectional study was conducted on 565 pregnant women visiting health centers of Tabriz, Iran, 2015. The participants were selected using the cluster sampling method. Data were collected using socio-demographic and obstetrics characteristics questionnaire, Edinburgh Postnatal Depression Scale, and a specific questionnaire for quality of life in pregnancy. Data were analyzed by SPSS, version 16. General linear model was used to estimate the effects of the independent variables (depressive symptoms and socio-demographic and obstetrics characteristics) on the dependent variable (quality of life).

The mean of the total score of quality of life was 2.9±0.3 from the achievable score range of 0-4. There was a significant negative correlation between depressive symptoms and quality of life (r=-0.53, P

The most important components affecting pregnant women’s quality of life are mother’s depressive symptoms, gestational age, and place of receiving prenatal care. Interventions such as screening and early treatment of depression must be implemented to improve the quality of life.

The aim of this study was to explore the men’s perceptions of being diagnosed with Klinefelter syndrome.
This qualitative study was conducted on five azoospermic men diagnosed with Klinefelter syndrome referring to two special infertility treatment clinics for males in Japan. The paqrticipants were selected through purposive sampling technique.The data were collected by semi-structured interviews within April 2013 to March 2015 and analyzed using a thematic analysis approach.
The analysis of the data resulted in the emergence of four themes, including ‘I cannot understand my diagnosis’, ‘the cause of my azoospermia was identified’, ‘I do not have any other healthcare problems besides Klinefelter syndrome’, and ‘Klinefelter syndrome means that I am more likely to have viable sperm’. Through these themes, we found that azoospermic men considered their diagnosis of the chromosomal disorder as good news; and as a reason for their infertility which might not affect their lives. Furthermore, they believed that having Klinefelter syndrome means that they are more likely to have their own child.
The men diagnosed with Klinefelter syndrome had various feelings about their diagnosis. They were hopeful about the outcome of undergoing micro dissection testicular sperm extraction (Micro-TESE). These findings are useful for healthcare workers and could raise their awareness; as they understand that those men with Klinefelter diagnosis have higher expectations regarding micro-TESE.

Empathy is an important component of establishing effective communication and achieving optimal clinical results. Establishing empathic communication with pregnant women improves satisfaction, mutual trust, participation in treatment, control over delivery process, and maternal health. Therefore, this study aimed to investigate the effect of empathy training on empathic skills of midwifery students of Mashhad University of Medical Sciences, Mashhad, Iran.
This quasi-experimental study was conducted on 73 midwifery students and 438 pregnant women in 2015. The students in the intervention group participated in the empathy training program including training on self-awareness and empathy skills, which was held in two 4-hour sessions for two consecutive days. Then each student was assessed by six pregnant women in terms of empathy behaviors. Data was collected using Jefferson Scale of Patient’s Perceptions of Physician Empathy. Data analysis was performed applying Chi-square, Mann-Whitney U, Wilcoxon, and paired and independent t-tests in SPSS software, version 16.
The pre-intervention empathy scores were 88.8±8.9 and 90.0±10.3 in the intervention and control groups. Therefore, there was no significant difference between the groups (P=0.591).The post-intervention empathy scores were 99.4±4.3 and 95.8±7.3 in the intervention and control groups, respectively. Despite the higher score of empathy in the intervention group, no significant difference was observed between the groups (P=0.063). However, the intragroup comparison demonstrated a significant increase in the post-intervention empathy score of the intervention group (99.4±4.3) in comparison to the pre-intervention score (88.8±8.9) (P Empathy training could increase the empathy score in midwifery students just in the intervention group. It is recommended to replicate the study in a larger sample.

The developing countries have the contraceptive prevalence rate of 43%. Contraceptive discontinuation accounts for a large number of unintended pregnancies in these countries. The present study aimed to investigate the factors associated with Cyclofem discontinuation.
This historical cohort study was conducted on 198 females, selected through cluster and Poisson sampling techniques. The first dose of Cyclofem was administered one month prior to the research. The data were collected using a questionnaire filled out through interviewing.
During the study period, only 3.94% of the health centers clients selected Cyclofem as a contraceptive method. The mean duration of Cyclofem use was 7.1±8.01 months. The likelihood of contraceptive continuation declined with increased consumption duration. Menstrual complications caused by this contraceptive method included irregular menstruation (35.4%) and neurological problems (14.6%). Furthermore, there were some personal reasons (8.1%) accounting for the discontinuation of this method. The frequency of Cyclofem use decreased with increased rate of menstrual irregularities (P=0.045) and spotting (P=0.020). Based on the participants’ reports, the most frequent complications were the medical ones. However, there was no significant difference between the females who continued Cyclofem use and those who discontinued (P=0.08). The majority of the participants reported no particular non-medical problems. The results revealed that the participants who used Cyclofem for a longer time stopped using this birth control method less commonly than those used it for a shorter time (P As the findings indicated, the most common reason for the discontinuation of Cyclofem was its associated side effects, especially menstrual irrigularities. Therefore, the healthcare providers should emphasize on the adverse effects of Cyclofem prior to recommending this contraceptive method.

Menopause is considered as a stage of life that is often encountered by all women with symptoms as hot flashes, sweating, palpitations, sleep disorders, and urinary tract problems. The improvement of health-promoting lifestyle behaviors is one of the effective measures to moderate these symptoms by facilitating the women to enhance their lifestyle behaviors through making proper choices. The aim of this study was to measure the effect of training based on choice theory on health-promoting lifestyle behaviors in menopausal women.
This two-group pretest-posttest design was conducted on 40 menopausal women within the age range of 45-55 years, referring to healthcare centers in Mashhad, Iran, in 2016. The subjects were randomly assigned into intervention and control groups using simple random sampling method. The data collection instruments included a demographic questionnaire, a menopause knowledge/attitude questionnaire, as well as Health-Promoting Lifestyle Profile II (HPLPII), which consisted of six dimensions of nutrition, physical activity, responsibility for health, stress management, interpersonal relationships, and spiritual growth. The intervention group received training in seven 90-minute sessions based on choice theory. The data were analyzed in SPSS software using descriptive statistics, Mann-Whitney U test, independent t-test, paired sample t-test, and Friedman test.
According to the results, after the intervention, the mean scores of total health-promoting lifestyle behaviors (P As the findings of this study indicated, the midwives could play an effective role in the moderation of menopausal side effects using choice theory. In this regard, the needs of the menopausal women in terms of boosting their awareness and practicing health-promoting lifestyle behaviors should be identified to deal with menopausal problems.

Happiness is one of the most important human needs that play an influential role in the health of the individuals and society. In the recent years, the role of spirituality and religion as important aspects of life has been considered in the health-related issues. The physical and mental health of the midwives plays a significant role in the quality of patient care. In this regard the current study was designed to investigate the relationship of spiritual intelligence and religious activities with happiness among midwivesworking in hospitals and health centers.
This descriptive cross-sectional study was conducted on 232 midwives working in the maternity hospitals and health centers affiliated to the Mashhad University of Medical Sciences, Mashhad, Iran, in 2015. The study sample was selected through cluster random sampling technique. The data were collected by the demographic and occupational characteristics questionnaire, life style questionnaire, Spiritual Intelligence Scale, and Oxford Happiness Questionnaire. Data analysis was performed using the descriptive statistics, Spearman’s rank correlation coefficient, Mann-Whitney U test, Kruskal-Wallis test, and multiple regression using SPSS, version 16.
According to the results, spiritual intelligence was directly correlated with happiness (r=0.63, P The findings revealed that happiness had a significant relationship with spiritual intelligence and religious activities. Therefore, we could improve happiness among the midwives by holding training and retraining courses with the purpose of involving in religious activities and promoting spiritual intelligence.

Despite the success of family planning programs in Iran in the recent decades, considerable proportions of pregnancies are still unintended and can be a cause of poor mental and physical health of the mother and child. The aim of this study was to investigate some important factors affecting uplanned pregnancies among married women in Semnan province, one of the developed provinces of Iran with below replacement fertility level.
The data for this study were drawn from a cross-sectional survey conducted in Semnan province in 2014. A total of 363 married women within the age range of 15-49 years who were pregnant or had the history of at least one delivery were considered. The study sample was selected using multi-stage stratified sampling method. The data were collected using a self-structured questionnaire with 90 items and Cronbach's alpha coefficient of 0.88. Data analysis was performed in SPSS (version 20) using Crammer’s V coefficients and Chi-square tests. Logistic regression analysis was also applied to model the risk of unintended pregnancies based on selected covariates.
According to the results, around 18.2% of the pregnancies were unplanned, 7.7% and 10.5% of which were mistimed and unwanted, respectively. Based on the logistic regression analysis, birth cohort, number of children ever born, and contraceptive methods had significant effects on the risk of unintended pregnancies. Furthermore, about 48% of the women experiencing unintended pregnancy were using a traditional contraceptive method before or at the time of the conception.
As the findings indicated, the women who used contraceptive method, as well as those with higher number of children and younger birth cohorts had higher risk of unplanned pregnancies. It should be noted that the majority of unplanned pregnancies among the women in younger birth cohort were mistimed pregnancies. So it is recommended to continue offering family planning and health services to these women in order to prevent unplanned pregnancy, unsafe abortion, and many chronic diseases.

Infertility can lead to a diminished sense of well-being and is associated with a high frequency of psychosomatic and somatic disorders. Generally, infertile women are more affected by infertility than men. This study aimed to determine factors influencing anxiety among infertile women undergoing in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
This cross-sectional study was conducted on 224 infertile women who were candidate for IVF/ICSI referred to Milad IVF Center, Mashhad, Iran, from September 2015 to July 2016. Prior to the treatment, the participants completed the demographic characteristics questionnaire and Beck Anxiety Inventory (BAI) to assess the level of anxiety. Additionally, a self-structured questionnaire containing the infertility-associated data including the duration and cause of infertility as well as history and the duration of treatment, was completed by the respondents. The subjects were selected through purposive sampling technique. Data analysis was performed using Mann-Whitney U, Kruskal-Wallis, Fisher exact test, regression tests, as well as Spearman’s correlation coefficient in SPSS software, version 16.
The results obtained from BAI showed that 38.4% of the subjects had moderate anxiety. There was a significant relationship between the level of anxiety and age (P=0.001), the cause of infertility (P=0.007), and the duration of treatment (P=0.001).
As the level of anxiety was higher in infertile women with younger age, female factor infertility and longer duration of treatment, it is recommended to consider this population more vulnerable and to provide them supportive counseling to be able to overcome their anxiety.

Birth asphyxia is a serious clinical problem and a leading cause of neonatal mortality and morbidity worldwide. The majority of neonatal deaths arise in low- and middle-income countries. We sought to address birth asphyxia and its associated factors among newborns delivered in Jimma zone public hospitals, Southwest Ethiopia.
A cross-sectional study was conducted on 368 live newborns born at Jimma zone public hospitals, who were enrolled in the study using the systematic random sampling method. Data were collected using a structured questionnaire, an observation checklist, and chart review, which were designed to measure the birth asphyxia and its associated factors. Overall, The data were analyzed using simple and multivariable logistic regression.
The prevalence of birth asphyxia was 32.9% in the first and 12.5% in the fifth minute. Accordingly, birth asphyxia was significantly associated with medical complications (AOR: 3.92, 95%CI: 1.62, 9.46), obstetric complications (AOR: 3.76, 95%CI: 1.71, 8.26), prolonged second stage of labor (> 3 h; AOR: 3.72, 95%CI: 1.46, 12.18), low birth weight (AOR: 4.21, 95%CI: 1.5, 12.2), meconium-stained amniotic fluid (AOR: 8.29, 95%CI: 3.6, 18.9), tight nuchal cord (AOR: 7.4, 95%CI: 1.6, 34.1), not attending antenatal care (AOR: 6.4, 95%CI: 2, 20.2), incomplete antenatal care visit (AOR: 4.6, 95%CI: 2.0, 10.5), non-cephalic presentation (AOR: 6.98, 95%CI: 2.66, 18.28), and caesarian section delivery (AOR: 2.3, 95%CI: 1.0, 5.1).
Most factors associated with birth asphyxia are manageable by means of good pre-natal care and improving antenatal, intrapartum, and neonatal care services within our limited resources.