Developing a policy brief to promote vaginal delivery in Iran

Cesarean section is one of the most common surgeries in the world and a worrying challenge for women’s health in developed and developing countries. According to the World Health Report, natural childbirth is an important indicator in improving the health of mothers. Therefore, providing suitable and safe conditions for childbirth is one of the most important health obligations of the country. The purpose of this study is to develop a policy brief to promote vaginal delivery in Iran. This multi-methods study was conducted in three phases of rapid review including a systematic search in Medline, SCOPUS, ISI Web of Knowledge, and Google Scholar; qualitative study of semi-structured interviews with obstetricians, health managers, midwives, and pregnant women; and two-round Delphi technique including panel of 15 experts. A rapid review of 23 studies revealed that the strategies employed to promote vaginal delivery can be categorized into four major policy domains of population, financial, institutional and clinical quality improvement, and educational, cultural, and awareness-raising. The main challenges to vaginal delivery, based on the qualitative phase, relates to mothers, infrastructure, and provider. Finally, the results of the expert panel showed that there are five policy options of maternal education and empowerment; improving the natural birth process based on women’s preferences; community education and advocacy; empowerment and satisfaction of service providers; and monitoring, evaluation, and performance tracking. In this study, a comprehensive set of practical and strategic policy options was developed for improving vaginal delivery in Iran. If implemented, these policies could play a critical role in promoting natural childbirth, subsequently reducing cesarean rates and helping address fertility challenges exacerbated by unnecessary surgical births.