Midwives' Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study.

Background: In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as a component of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage natural childbirth practices and reduce cesarean section rates. The purpose of this qualitative study was to explore the perceptions of midwives about conditions influencing the implementation of NCPP.

Methods: In this qualitative study, data were collected through 21 in-depth semi-structured individual interviews with expert midwives who were selected using purposive sampling mainly from one medical university in Eastern Iran from October 2019 to February 2020. Based on the framework method as a thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, we followed Lincoln and Guba's criteria.

Results: Data analysis yielded 546 open codes. After the codes were reviewed and similar codes were removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes, 19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristics of the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effective management; Institutional and social context; and Social education.

Conclusion: Based on the perceptions of the studied midwives, the success of the NCPP is guaranteed by a set of conditions identified in this study. In practice, these conditions are complementary and interrelated, and they cover a wide range of staff and parturient characteristics to the social context. It seems that effective implementation of the NCPP also calls for the accountability of all stakeholders, from policymakers to maternity care providers.