Identifying determinants of obstetrics method choice in Iranian women: A scoping review

Background and Objective: Although many national efforts have been made to promote natural childbirth in Iran, the cesarean section rate is still significantly higher than the global recommended rate. To understand this complex phenomenon, we need to examine the determinants at different levels. The aim of this scoping review is to identify and categorize the various factors affecting the choice of delivery method among Iranian women in order to provide a clear conceptual framework for future research and interventions. Methods: This study was conducted as a scoping review based on the methodological framework (Arksey & O'Malley) and in accordance with the PRISMA-ScR guidelines. A systematic search was conducted in PubMed, Scopus, and Web of Science databases. Keywords related to "delivery method choice", "cesarean section", "natural childbirth", "influencing factors", and "Iran" were used from the beginning of the year. ۲۰۰۰ to the end of April ۲۰۲۴. The screening process of titles, abstracts and full texts was carried out in two stages by two independent researchers, and data related to influential factors were extracted from eligible studies and categorized using an inductive qualitative content analysis approach. Findings: Data analysis led to the emergence of a multi-level framework of determinants: these factors included ۱) the individual-psychological level, including health beliefs, fear of pain, low self-efficacy, and insufficient knowledge; ۲) the interpersonal level, including the influence and direct advice of the spouse, mother, friends, and, most prominently, the attending physician and midwife; ۳) the socio-cultural level, including social norms favoring cesarean section as a symbol of modernity, attitudes related to social class, and the increasing influence of fear-mongering narratives on social networks; ۴) The structural-economic level included health insurance status, family income, place of residence (urban/rural), and quality of access to natural childbirth support services; and ۵) The policy and planning level included the impact of national incentive or punitive schemes and the financial performance of hospitals. Conclusion: The choice of delivery method in Iran is a multifaceted phenomenon rooted in the psychosocial and cultural context of society. Successful interventions to reduce cesarean section should adopt an integrated and multilevel approach.

کلیدواژه ها:

Iranian ، Women ، cesarean ، childbirth