title: Decision-making for vaginal delivery in the North of Iran: A focused ethnography.
abstract: BACKGROUND
  Many factors have been mentioned to influence decision-making for different kinds of delivery. Decision-making for vaginal delivery is under the influence of culture, perceptions, beliefs, values, attitudes, personalities, and knowledge. The current study aims at exploring the determinants of decision-making for vaginal delivery in the north of Iran from women's perspective.
  
  
  METHODS
  A focused ethnographic method with purposeful sampling method has been used. Semi-structured interviews and observation were conducted with 12 pregnant women and 10 delivered women, 7 midwives, 7 gynecologists, and 9 non-pregnant women in Tonekabon clinics. Interviews and observations were recorded and transcribed. The accuracy of the extracted codes and themes was confirmed by restoration of the arranged and coded texts to the participants (member check) and by an expert person from outside the study context. Data were analyzed using thematic analysis and MAXqda software.
  
  
  RESULTS
  Five themes were extracted from the data: Economic influencing factors, Cultural values and norms related to normal childbirth, Positive attitudes towards vaginal delivery, Role of important others, and Facilitators of natural birth. Several sub-themes and sub-sub themes also emerged from the data (e.g. safe delivery, forming maternal feelings, painful but tolerable, maternal role facilitator, inexpensive delivery, a process with good outcome and less complications, relief messenger).
  
  
  CONCLUSIONS
  Giving enough information about vaginal delivery for pregnant women and their family members, training pregnant women to increase tolerance during labor pain, and modifying expenses can increase economic affordability, positive cultural norms and attitudes about vaginal delivery, proper social support, use of normal delivery facilitators, and direct them toward vaginal delivery.
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Zakerihamidi
authors.affiliation: Evidence-based Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Robab Latifnejad
authors.initials: RL
authors.lastname: Roudsari
authors.affiliation: Iranian National Center of Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Effat Merghati
authors.initials: EM
authors.lastname: Khoei
authors.affiliation: Department of Biostatistics, Tarbiat Modares University, Tehran, Iran.
authors.forename: Anoshirvan
authors.initials: A
authors.lastname: Kazemnejad
keywords: Culture; decision-making; focused ethnography; qualitative study; vaginal delivery