Designing of educational,financial and revisional interventions of human factors and structural agents on cesarean rate reduction ,administration and evaluation of them in Shahroud and comparison with cesarean rate in adjucent cities

The present study is an integrative multilateral program that aims to maternal and neonatal health promotion. Objectives: 1- To determine perceived threat of unnecessary cesarean morbidity in pregnant women 2- To determine perceived self efficacy of unnecessary cesarean morbidity in pregnant women 3-To determine women ‘intention to delivery mode in pregnant women 4-To determine women ‘knowledge about delivery mode in pregnant women 5- To increase women's intention at least 80% to vaginal birth at the end of the educational sessions 6-To increase cesarean rate of participants in Shahroud in comparison of participants in other cities of Semnan Province Our approach concludes two stages:1- Designing the model 2- Administrating and evaluation of model Designing the model comprise the main factors effect on decision and performing cesarean surgery. Our interventions conclude: 1- Goal oriented trainings of birth skills to obstetricians and midwives in Shahroud to instruct the pregnant mothers 2- Structured instructions to pregnant women in prenatal classes during 8 sessions 3- Revision of fee for services for obstetricians, anesthesiologists and midwives 4- Amending the labor/delivery ward in order to decrease the fear and anxiety of labored women Sample size is 220 pregnant women in experiment and control groups Interventions: Instructions of necessary educations about physiologic delivery on the basis of "Extended Parallel Process Model" or EPPM during 8 sessions as prenatal educations and learning pain and fear control skills for childbirth for women in experiment group, whereas women in control do not get such educations but regular prenatal care. Inventory is a structured questionnaire through EPPM that will be given participants in experiment group before and after educations and subjects in control group near the expected date of delivery. Main constructs of EPPM and "knowledge and intention" will be compared in two groups. Final outcome is the mode of delivery that will be compared in two groups and the effectiveness of educations will be evaluated. Inclusion criteria include: no history of former cesarean of uterine surgery , general wellbeing with no indication for medical/surgical intervention , Persian literacy , singleton pregnancy and cephalic presentation , No scientific approved indication for cesarean surgery , Being at 18 gestational weeks and singleton pregnancy and cephalic presentation Exclusion criteria: Every induced systemic disease during present pregnancy which needs to medical or surgical intervention and every obstetrical/non obstetrical indication for cesarean section Finally, cesarean rates will be compared in Shahroud and other adjacent cities in Semnan Province during study time

Vice chancellor for research and education , Shahroud University of Medical Sciences with collaboration of Health Deputy, Treatment Deputy and Logistic Deputy.