title: The Impact of Healthcare Reform Plan on the Rate of Vaginal Delivery and Cesarean Section in Shiraz (Iran) in 2015.
abstract: BACKGROUND
  The uncontrolled increase in the rate of cesarean section is one of the most controversial issues, and is a primary challenge among health policy makers. This study was conducted to examine the impact of the Iranian health evolution plan on vaginal delivery rate and cesarean section.
  
  
  METHODS
  This cross-sectional study was carried out in 2014. Maternal health data for 2013 and 2014 were used in this study and changes in vaginal delivery and cesarean section were compared before and after the reform, using t-test and Wilkinson test.
  
  
  RESULTS
  According to the findings of this study, 64.7% of deliveries in 2013 were performed using cesarean section while it was 58.6% in 2014 (p= 0.772), of which no significant changes were observed. In addition, the percentage of vaginal delivery in 2013 and 2014 were 35.3% and 41.4% respectively (p= 0.00), so a significant increase was found for vaginal delivery.
  
  
  CONCLUSIONS
  Healthcare reform has led to an increase in the number of vaginal deliveries in hospitals affiliated to Shiraz University of Medical Sciences (SUMS). Due to the limited number of hospitals adhering to the healthcare reform plan to increase vaginal delivery (using private midwife and implementing painless delivery), the reform for decreasing the cesarean rate was not effective enough.
authors.affiliation: M.Sc., Department of Healthcare Management, Fars Science and Research Branch, Islamic Azad University, Marvdasht Iran.
authors.forename: Faranak
authors.initials: F
authors.lastname: Rooeintan
authors.affiliation: Ph.D., Assistant Professor, Department of Medical Education Management, Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
authors.forename: Parviz Aghaei
authors.initials: PA
authors.lastname: Borzabad
authors.affiliation: Ph.D., Assistant Professor, Department of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Yazdanpanah
keywords: Cesarean section; Healthcare reform plan; Vaginal delivery