Effects of Recruiting Midwives into a Family Physician Program on Women's Awareness and Preference for Mode of Delivery and Caesarean Section Rates in Rural Areas of Kurdistan

<div><p>Background</p><p>The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density.</p><p>Methods</p><p>In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline.</p><p>Results</p><p>After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03–0.25) in women’s awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women’s preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22–0.85); P>0.001).</p><p>Conclusions</p><p>The results of this study showed that an increase in the density of midwives in the family physician program led to an increase in women's awareness of the benefits of natural childbirth. An increase in women’s awareness of the benefits of natural childbirth was associated with a decreased preference for caesarean section, however this reduction did not have a significant impact on caesarean section rates; possibly, this finding might be attributed to the complexity of this problem that needs a mixed strategy involving various stockholders.</p></div

Difference in difference modeling on women’s preference for caesarean section and undergoing caesarean section in rural areas of Kurdistan province.

<p>Difference in difference modeling on women’s preference for caesarean section and undergoing caesarean section in rural areas of Kurdistan province.</p

A simplified structure of PHC network in rural areas of Iran [29].

<p>A simplified structure of PHC network in rural areas of Iran [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151268#pone.0151268.ref029" target="_blank">29</a>].</p

Sampling frame in rural area of Kurdistan province in the survey of 2005 and 2013.

<p>Sampling frame in rural area of Kurdistan province in the survey of 2005 and 2013.</p

Density distribution of midwives, family physicians and Bhevarzes in health centers in the survey of 2005 and 2013.

<p>Density distribution of midwives, family physicians and Bhevarzes in health centers in the survey of 2005 and 2013.</p

The estimated effect on increasing inthe density of midwives in family physician program according to Matchit model on caesarean section, women’s preference for caesarean section, and women’s awareness of the benefits of natural childbirth in the rural health centers in Kurdistan province.

<p>The estimated effect on increasing inthe density of midwives in family physician program according to Matchit model on caesarean section, women’s preference for caesarean section, and women’s awareness of the benefits of natural childbirth in the rural health centers in Kurdistan province.</p

Characteristics of the study population by Intervention in family physician program (2005: N = 668, 2013: N = 668).

<p>Characteristics of the study population by Intervention in family physician program (2005: N = 668, 2013: N = 668).</p

Difference in difference modeling on women’s awareness of the benefits of natural childbirth in rural areas of Kurdistan province.

<p>Difference in difference modeling on women’s awareness of the benefits of natural childbirth in rural areas of Kurdistan province.</p

Comparison of the Association of Excess Weight on Health Related Quality of Life of Women with Polycystic Ovary Syndrome: An Age- and BMI-Matched Case Control Study

<div><p>Background</p><p>It is assumed that obesity adversely affects the health related quality of life (HRQOL) of women with polycystic ovary syndrome (PCOS), not only due to the excess weight, but also due to several other obesity induced metabolic and reproductive consequences. We aimed to compare the effects of excess body weight on the HRQOL between women with PCOS and controls.</p><p>Methods</p><p>This is a case control study of 142 women with PCOS and 140 age- and BMI- matched controls. The Iranian version of short form health survey 36 (SF 36) was used to assess HRQOL. Domains of SF 36 were compared in women with PCOS and controls using multivariate analysis of covariance. The Pearson correlation was used to assess the correlation between body mass index (BMI) and domain scores of SF 36, and the differences between two correlations in cases and controls, using Fisher’s Z test.</p><p>Results</p><p>Women with PCOS had significantly lower scores for both, the physical and the mental component summary scales, compared to controls. In the cases, a significant negative correlations were observed for BMI with physical function (r = - 0.301, P<0.001), bodily pain (r = - 0.23, P = 0.006), and physical summary score (r = -0.3, P = 0.007). In controls, significant correlation was seen for BMI with bodily pain (r = - 0.3, P<0.001) and physical summary score (r = - 0.27, P = 0.001). The differences between correlations of physical function with BMI in PCOS and controls were statistically significant (Z = -2.41, P = 0.008).</p><p>Conclusion</p><p>Although the physical aspects of HRQOL are adversely affected by overweight in both PCOS and controls, these impaired effects are greater in women with PCOS.</p></div

Mean scores of 26 items and five PCOSQ domains in the study population.

<p>Mean scores of 26 items and five PCOSQ domains in the study population.</p