Table 2 Strategies for promoting midwifery care in Iran from the perspective of midwifery experts (N = 121)
Area | ||
Promotion and development of education | University | Paying special attention to the quality of midwifery student’ education and selecting their instructors based on specific criteria. The education of midwifery students should be revised so that they are committed and efficient after graduation. Increasing the training course of midwifery students to 5.5 years Use of midwives with theoretical and clinical experience and for education of midwifery students. |
Graduate and in-service training | Holding a training course on childbirth preparation for midwives in the health centers. Training of new employed staff Continuous and codified training for midwives in the maternity ward Periodic training for midwives of health centers for proper control of mothers of prenatal education. | |
Educating the community | Promote natural childbirth using the media and install advertising banners Educating pregnant mothers in health centers about natural childbirth Obligation to teach the benefits of natural childbirth in pre marriage counseling classes Creating a culture about natural childbirth and the complications of cesarean section, especially on television | |
Manpower management | Management of midwifery forces | ➢Creating new positions of employment for midwives ➢Employment based on skills, efficiency and scientific knowledge ➢Using midwives in clinical fields ➢Providing permission to employ midwives for clinical work |
Midwifery management | ➢Stablishing of midwifery supervisor ➢Presence of midwives in managerial positions ➢Attending to maternal mortality committess | |
Supportive and incentive systems | ➢Payments of natural births to midwives in hospitals ➢Legal protection of midwives in the private sector ➢Reform of payment system ➢Increase the difficulty of midwifery job to 100% ➢Creating motivation by assigning of in charge midwife to the head of delivery ward | |
Rules and standards for midwifery services | Regulations on the professional qualifications of midwives | ➢Revise the midwifery duties ➢Full implementation of the letter description section of midwife duties |
Audit and supervision | ➢Existence of reprimand tools for specialists who perform elective cesarean section or make unscientific decisions ➢Establish a strong system for monitoring cesarean section indications ➢Supervise the implementation of letters related to midwifery and protocols | |
Equipment and Facilities | ➢Maternity facilities should be rehabilitated ➢Equipping hospitals with 24-h physiological delivery wards ➢Standardization of delivery ward space in all hospitals ➢Modification of physical environment of hospitals for rapid access of clients in time of emergencies | |
Policy making | Organization | ➢Determining the appropriate position of midwives in the family physician and referral program ➢Hospitals should not be self-government |
Compliance with the general policies | ➢Using the words of the Supreme Leader of Iran in relation to population growth and natural childbirth to decrease cesarean section ➢Improving lifestyles and changing beliefs in order to implement general health policies | |
Interdisciplinary activities | ➢Development of team activity protocols for midwives and gynecologists ➢Increase interaction between private universities and the Ministry of Health ➢Holding periodic symposiums between midwives of the private and national universities. | |