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Background: Childbirth constitutes a significant milestone in a woman's life, influencing both her physical and mental well-being as well as her relationship with the child. Employing a birth plan (BP) can contribute positively to obstetric outcomes, enhancing the overall birthing experience for women. BPs are not universally embraced in many countries, and there is limited research on women's experiences with BP in Iran. This study seeks to explore and understand the perspectives of women who have utilized a BP during their delivery. Methods: This qualitative study included 14 women who had BP and experienced delivery. Data was collected through in-depth, semi-structured individual interviews. The sample selection followed a purposive approach, and data analysis utilized content analysis with a conventional approach facilitated by MAXQDA software version 2020. Results: The examination of pertinent data concerning women's experiences identified five key themes: preparation, participation, support, emotional well-being, and unmet expectations. Conclusions: This study's findings indicate that BPs enhance the overall birthing experience, suggesting their potential utility in improving the quality of obstetric care. Nevertheless, additional studies are essential to validate these results on a broader scale and facilitate the nationwide implementation of BPs.

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BACKGROUND: The birth plan is an approach for pregnant women to offering their expectations of labor and birth. The purpose of this study was to investigate the effect of birth plan on maternal and neonatal outcomes. METHODS: This study was a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran. Participants were randomly assigned to the two groups of birth plan and control using a randomized block method. Participants in the birth plan group received the interventions based on the mother's requested birth plan. The birth plan included items of the mother's preferences in labor, mobility, eating and drinking, monitoring, pain relief, drug options, labor augmentation, pushing, amniotomy, episiotomy, infant care, and caesarean section. The control group received routine hospital care. The primary outcomes were childbirth experience and duration of the active phase of labor and the secondary outcomes were support and control in labor, fear of labor, post-traumatic stress disorder (PTSD), postpartum depression, duration of the second and third phases of labor, frequency of vaginal delivery, frequency of admission of newborn in NICU (Neonatal Intensive Care Unit), the mean first and fifth minute Apgar scores. The socio-demographic and obstetrics characteristics questionnaire, Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-versions A), and Edinburgh Postnatal Depression Scale (EPDS) were completed at the beginning of the study (at the gestational age of 32-36 weeks). The questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) was completed during and after the delivery. Also, a partogram was completed for all participants by the researcher. The participants in both groups followed up until 4-6 weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire 2.0 (CEQ2.0), Support and Control In Birth (SCIB) scale, EPDS, and PTSD Symptom Scale 1 (PSS-I) were completed by the researcher through an interview. The independent t-test, the chi-square test, and ANCOVA was used to analyze. RESULTS: The mean (SD) of CEQ score was singificnalty higher in in the birth plan group (3.2 ± 0.2) compared to the control (2.1 ± 0.2) (MD = 1.0; 95% CI: 1.1 to 0.9; P˂0.001). Also, the mean (SD) SCIB score in the birth plan group was significantly higher than that of those in the control group (P˂0.001). The mean scores of DFS (P = 0.015), EPDS (P˂0.001), and PTSD (P˂0.001) as well as the frequency of emergency caesarean section (P = 0.007) in the birth plan group were significantly lower than those in the control group. CONCLUSION: This was the first study to assess the implementation of a birth plan in Iran. Based on the findings, a birth plan improves childbirth experiences; increases perceived support and control in labor; reduces fear of delivery; suppresses psychological symptoms of depression and PTSD, and increases the frequency of vaginal delivery. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: 07/07/2020; URL: https://en.irct.ir/trial/47007 ; Date of first registration: 19/07/2020.

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AIM: To determine the relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women. METHODS: This prospective study was conducted on 316 adolescent pregnant women with medical records at the health centers in Tehran, Iran. The participants were selected through the complete enumeration. Data were collected using the socio-demographic and obstetrics questionnaire, the Health Practices Questionnaire-II (HPQ-II), the Edinburgh Postnatal Depression Scale (EPDS), and the Cranley's Maternal-Fetal Attachment Scale (MFAS). The data were analyzed with the Pearson correlation test, the independent t-test, one-way ANOVA, and the general linear model. RESULTS: The mean scores of health practices, depression, and maternal-fetal attachment were 135.3 (SD 9.1, range 34-170), 10.1 (SD 5.4, range 0-30), and 91.6 (SD 8.6, range 24-120), respectively. The results of Pearson correlation test showed that health practices had a significant relationship with depression (r = -0.29) and maternal-fetal attachment (r = 0.37). Results of general linear model showed that an increase in the health practices score led to a significant decrease in depression score during pregnancy [ß = -0.10; 95% CI: -0.17 to -0.04] and a significant increase in maternal-fetal attachment score [ß = 0.30; 95% CI: 0.19 to 0.40]. CONCLUSION: There is significant relationship between health practices and depression, as well as maternal-fetal attachment in adolescent pregnant women. Therefore, intervention to improve one of them may improve the other one(s).

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BACKGROUND: The potential for the secondary use of electronic health records (EHRs) is underused due to restrictions in national legislation. For privacy purposes, legislative restrictions limit the availability and content of EHR data provided to secondary users. These limitations do not encourage healthcare organisations to develop procedures to promote the secondary use of EHRs. OBJECTIVE: The objective of this study is to identify factors that restrict the secondary use of unstructured EHRs in academic research in Finland and Sweden. METHOD: A study was conducted to identify these availability-restricting issues that pertain to the academic secondary use of unstructured EHRs. Using semi-structured interviews, 14 domain experts in science, hospital management and business were interviewed to evaluate the efficiency of procedures and technologies that are implemented in secondary use processes. RESULTS: The results demonstrate three aspects that restrict the availability of unstructured EHRs for secondary purposes: (i) the management and (ii) privacy preservation of such data as well as (iii) potential secondary users. CONCLUSION: Based on these categories, two approaches for the secondary use of unstructured EHRs are identified: the protected processing environment and altered data. IMPLICATIONS: The protected processing environment ensures patient privacy by providing unstructured EHRs for exclusive user groups that have preferred use intentions. Compared to the use of such processing environments, data alteration enables the secondary use of unstructured EHRs for a larger user group with various use intentions but that yield less valuable content.

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AIMS: To evaluate the effect of metformin and insulin in glycemic control and compare pregnancy outcome in women with gestational diabetes mellitus (GDM). METHODS: This randomized controlled trial was conducted in GDM women with singleton pregnancy and gestational age between 20 and 34 weeks who did not achieve glycemic control on diet were assigned randomly to receive either metformin (n=80) or insulin (n=80). The primary outcomes were maternal glycemic control and birth weight. The secondary outcomes were neonatal and obstetric complications. RESULTS: Two groups were comparable regarding the maternal characteristics. Two groups were similar in mean FBS (P=0.68) and postprandial measurements (P=0.87) throughout GDM treatment. The neonates of metformin group had less rate of birth weight centile >90 than insulin group (RR: 0.5, 95% CI: 0.3-0.9, P=0.012). Maternal weight gain was reduced in the metformin group (P<0.001). Two groups were comparable according to neonatal and obstetric complications (P>0.05). In metformin group 14% of women needed to supplemental insulin to achieve euglycemia. CONCLUSION: Metformin is an effective and safe alternative treatment to insulin for women with GDM. This study does not show significant risk of maternal or neonatal adverse outcome with the use of metformin.

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