title: Vaginal Delivery vs. Cesarean Section: A Focused Ethnographic Study of Women's Perceptions in The North of Iran.
abstract: BACKGROUND
  Cesarean section (C-section) in the North of Iran accounts for 70% of childbirths, which is higher than the national average of 55%. Understanding women's perceptions towards modes of delivery in different cultures can pave the way for promoting programs and policies in support of vaginal delivery. We aimed to investigate women's perceptions towards modes of delivery in the North of Iran.
  
  
  METHODS
  Using a focused ethnographic approach and purposive sampling, 12 pregnant women, 10 women with childbirth experience, nine non-pregnant women, seven midwives, and seven gynecologists were selected from hospitals, healthcare centers, and clinics of Tonekabon and Chaloos, Mazandaran, Iran, during 2012-2014. Data were collected through in-depth interviews and participant observation. Data analysis was performed using thematic analysis using MAXqda software.
  
  
  RESULTS
  Two major themes emerged from the data including: "vaginal delivery, a facilitator of women's physical and mental health promotion", and "C-section, a surgical intervention associated with decreased labor pain". Six sub-themes subsumed within these major themes were: vaginal delivery as a safe mode of delivery, fullfilment of maternal instinct, a natural process with a pleasant ending, and C-section as a procedure associated with future complications, a surgical intervention and sometimes a life saving procedure, and a painless mode of delivery.
  
  
  CONCLUSIONS
  In the North of Iran, women's justified cultural beliefs overshadow their micsconceptions, so it is hopped that through implementing appropriate training programs for raising awarness and correcting miscomceptions, vaginal delivery could be promoted even in regions with high rates of cesarean section.
authors.affiliation: Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran;
authors.forename: Maryam
authors.initials: M
authors.lastname: Zakerihamidi
authors.affiliation: Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran;
authors.forename: Robab
authors.initials: R
authors.lastname: Latifnejad Roudsari
authors.affiliation: Iranian National Center of Addiction Studies, Institution of Risk Behavior Reduction, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Effat
authors.initials: E
authors.lastname: Merghati Khoei
keywords: Cesarean section; Ethnography; Natural childbirth; Pregnant women