Analysis of vaginal delivery promotion package in the National Health System Reform Plan in Iran: a qualitative study

Background: The Vaginal Delivery Promotion Package was a part of the National Health System Reform Plan in Iran, which was implemented to reduce the rate of cesarean sections. The aim of the present study was to examine the views of the beneficiaries on the implementation of the promotion of natural vaginal delivery in the hospitals affiliated to Tehran University of Medical Sciences. Methods: A qualitative study conducted in 2016 using semi-structured interviews for data collection. The sampling method was purposeful with maximum variation of the beneficiaries. After doing 35 interviews, the data reached a saturation point. Data analysis was done through content analysis method using MAXQDA 10 software. Results: The package beneficiaries believed that it was successful in achieving its goal to reduce cesarean sections. Their perspectives were classified into two categories (strengths and weaknesses), eight themes (package design, achieving the goals, education and persuasion, package comprehensiveness, monitoring, infrastructures, plan implementation, and service quality), and 24 sub-themes. The most important weaknesses of this package were the payments and supervisions. Conclusion: Officials and policymakers can improve the package by continuous monitoring, providing necessary feedback to the staff, and modifying the payments. Besides, paying attention to midwives and health workers, the first contact point for pregnant mothers with service providers, can increase the effectiveness of this package.