title: Salient beliefs towards vaginal delivery in pregnant women: A qualitative study from Iran.
abstract: BACKGROUND
  Childbirth by cesarean section has increased at an alarming rate over the past few years in Iran. The present study was designed to explore pregnant women's beliefs about the mode of delivery in order to provide some suggestions for future interventions to increase vaginal delivery.
  
  
  METHODS
  This was a qualitative study framed by the Theory of Planned Behavior conducted in Tehran, Iran in 2013. Pregnant women attending public hospitals were recruited. The data were collected via in-depth interviews and focus group discussions. Interviews were conducted in a semi-structured manner. All interviews were tape recorded and transcribed verbatim. A content analysis approach was used to explore the data.
  
  
  RESULTS
  In all 36 pregnant women participated in the study. The mean age of women was 27.8 (SD = 4.5) years. In general, women preferred vaginal delivery. During interviews and focus group discussions several themes emerged related to the pain associated with vaginal delivery, fears of childbirth, related health concerns, and the role of decision makers. The findings were grouped into three main themes namely: behavioral beliefs (negative and positive beliefs towards outcomes of vaginal delivery), normative beliefs (injunctive norms and descriptive norms), and control beliefs (internal and external barriers).
  
  
  CONCLUSIONS
  Despite the fact that there were positive beliefs regarding vaginal delivery, participants indicated concerns related to loss of control and fear. It is essential that health care providers realize the psychological needs of women during pregnancy and the need for continuous support during childbirth. This type of support may improve their self-control during labor, and decrease fear of childbirth.
authors.affiliation: Department of Midwifery, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran.
authors.forename: Parvin
authors.initials: P
authors.lastname: Rahnama
authors.affiliation: Department of Midwifery, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran.
authors.forename: Khadigheh
authors.initials: K
authors.lastname: Mohammadi
authors.affiliation: Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran. montazeri@acecr.ac.ir.|Faculty of Humanity Sciences, University of Science & Culture, ACECR, Tehran, Iran. montazeri@acecr.ac.ir.
authors.forename: Ali
authors.initials: A
authors.lastname: Montazeri
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000523:psychology; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D007492:Iran; D010298:Parity; D010353:Patient Education as Topic; D057240:Patient Preference / Q000208:ethnology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D036301:Qualitative Research; D013315:Stress, Psychological / Q000208:ethnology / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult