Designing a Model for Effective Implementation of Promoting Natural Childbirth Program: A Mixed Study

Background: The World Health Organization (WHO) has considered the ideal rate for cesarean sections to be 10 - 15%. The Iran Ministry of Health introduced the promoting natural childbirth program (PNCP) in 2014 to lower cesarean sections. Objectives: This study presents a model for the implementation of the PNCP. Methods: A mixed study was conducted to determine and prioritize the factors affecting the implementation of PNCP and present a model. We conducted a qualitative study to determine the effective factors of the program by examining the views of 15 gynecologists, anesthesiologists, midwives, and managers in 2019 at Zabol Medical Sciences University. Semi-structured individual and group interviews were used and analyzed with MAXQDA16. In the quantitative phase, a questionnaire of themes was prepared and ranked by 10 experts based on the Likert scale. Then, we used the technique for order performance by similarity to ideal solution with BT TOPSIS solver software to confirm and rank the themes and design a model. Results: The model included six main themes extracted from the qualitative phase. In the quantitative phase, they were approved and prioritized by experts in the following order: 1) Creating a Culture for Natural childbirth, 2) Strong and committed leadership, 3) Empowerment, 4) Education, 5) Comprehensive support, and 6) Optimization. Conclusions: The model can provide useful insight for policymakers and care providers to make more qualified decisions, determine the status quo, allocate resources, and enforce policies.