METHODOLOGY

In this study, the database of hospitals was used to collect data. Separate data related to the causes of cesarean section were introduced from the hospitals’ delivery offices to the Excel form and then statistical methods were used to analyze the data. In the first step, we describe the information using descriptive statistics methods, which includes average, standard deviation, minimum and maximum amounts, and plotting the charts and graphs. Then, using inferential statistics including independent t test and one way and two-way analysis of variance analysis, we analyze the information. SPSS software version 24 and Excel 2010 was used to analyze the data of this research. The current research is descriptive analytical and in terms of applied purpose. This study was conducted longitudinally in the year 2016 on the information collected about the deliveries before and after the development of the health system in hospitals affiliated with Yasouj University of Medical Sciences. In this regard, comparing the statistics of year 1992 as the base year, one year before implementation of the health care reform plan with the data of 1993, 1994 and 1995, was performed three years after the implementation of the health system reform plan. Also, training was completed for the completion of the form to the delivery staff. The statistical population includes all pregnant women who were referred to hospitals with delivery blocks in Kohgiluyeh and Boyerahmad provinces (university hospitals including Imam Sajjad (AS), Shahid Rajai, Imam Khomeini (RA) and non-university hospitals including Besat, Gomnam Shohada and Zagros) and were first cesarean deliveries. These statistics were compared. The sample is the same as the statistical population. Also, the moral rights of the university were reserved.

RESEARCH FINDINGS

In Table 1, the descriptive information related to the percentage of cesareans is reported for the first time in the entire province. On average, the percentage of cesarean deliveries was 37.44 before the implementation of the health promotion plan and after running it, it was 28.75. The dispersion of data is based on standard deviations and the lowest and maximum values are approximately the same.

In Table 2, descriptive information regarding the percentage of cesarean sections among the university centers is reported.

On average, the percentage of cesarean delivery is 29.59 before the implementation of the Health Promotion Plan, and after the implementation of it are 29.20. The dispersion of data is based on standard deviations and the lowest and the most different values and dispersion of information for the percentage of cesareans is more common among university centers before implementing a health promotion plan and this should be taken into consideration when using the test.

In Table 3, descriptive information about the percentage of cesarean sections among non-university centers is reported. On average, the percentage of cesarean delivery is 43.93 before the implementation of the Health Promotion Plan, and after it is 37.20. The dispersion of data is based on standard deviations and the lowest and maximum values are approximately the same.

According to Table 4, independent T-test data for the first cesarean were reported after the implementation of the Health Promotion Plan. Considering the equality of variances (F = 0.39, p = 0.53 <0.05), the value of the T 2.3 was statistically significant, which was significant based on p-value of 0.00 (> 0.05). Therefore, the hypothesis of equality of means before and after. On the other hand, the percentage of cesarean sections had a significant change in the level of 5% after the implementation of the health system reform plan. As shown in the table; an average of 8% was counted for the first cesarean.

According to Table 5, independent t-test data for the percentage of cesarean section at university centers before and after implementation of the health promotion plan are presented. Due to the lack of equality of variances (F = 44.73, p = 0.00), the t-test was found to be 29.5, which is significant based on the p-value of 0.00. Therefore, the hypothesis of equality of meanings after project implementation is rejected at a significant level of 5%. In other words, the percentage of cesarean section in the university centers has changed significantly at 5% level. As shown in the table, an average of 9.26% of the cesarean sections has been reduced for the first time.

According to Table 6, independent T-test data for the percentage of first cesarean in non-university centers before and after implementation of the health promotion plan have been presented. Considering the equality of variances (F = 1.40, p = 0.24), the value of T 45.1 was obtained, which is not significant at the p-value of 0.15, and so the hypothesis of equality of meanings after the implementation of the plan is not rejected at a significant level of 5%; In other words, the percentage of first cesarean has not changed in the non-university centers since the implementation of the health promotion plan. As shown in the table, an average of 6.72% of the first cesarean was decreased, but this decline is not statistically significant.

DISCUSSION AND CONCLUSIONS

In order to provide, maintain and promote the health of mothers and infants and to improve the conditions of delivery, promotion of normal delivery was included in the guidelines for the development plan and implementation of this plan has provided satisfaction to all segments of society (Farzighi et al., 2015). Childbirth can be considered one of the most beautiful events in women’s lives (the acquisition of motherhood) and at the same time a tense reality. Sometimes it is difficult to prevent the risk of a mother or newborn baby and so delivery of cesarean section can be done as a lifesaver (Zahedi et al., 2015). But in many cases, cesarean is not due to medical necessity, but the unwillingness of women to give birth in a natural way (Aghayee et al., 2015). Attitudes, behaviors and misconceptions (Badie Aval et al., 2011) and social and economic factors determine the type of delivery (Delaram and Vardis, 1997). Fear of the inability of normal delivery and associated pain (Yvonne et al, 2016) and reducing pelvic floor injury are factors (Alderdic et al, 2003). And choosing cesarean as a way for physicians and family to set their work and life plans is another reason for more women choosing cesarean section (Khani and Shabankani, 2004). To reduce non-emergency cesareans, it is necessary to delay early admission of primipara women in latent phase and the most common cause of their cesarean section is fetal distress, until the patient has entered the active phase of the delivery, unless there is indication for admission (Rahnama, 2005).

Different non-pharmaceutical methods may also be used to induce labor (Aghamohamadi et al., 2014). Instead of using oxytocin, it is possible to use other methods such as catheter to prepare the cervix and terminate the pregnancy in pregnant women, which is effective and safe and has a more favorable delivery outcome and it somewhat reduces surgical interventions (Malekzadegan et al., 2008). There are other ways to reduce cesarean delivery, including the continuous presence of midwife at the mother’s bedside and providing effective emotional and physical support during delivery (Muslim Abadi Farahani et al., 2006). Participating in childbirth classes is evident in reducing the fear of giving birth and increasing normal delivery in nursing women attending these classes (Abuzari Gozafroudi et al., 2015). Delivery in water due to reduced labor length and reduced pain and decreased need for medical interventions can be a suitable substitute for selective cesarean section (Akbari et al., 2008) and the use of pain relief methods, especially non-prescription pain relief methods that are less costly and have less side effects, can promote normal delivery and make the beautiful birth process a memorable one for the mother (Rahmanian, 191).

Seidali and Namazi, in a descriptive study in the Shoosh hospital of Khuzestan, in 1993, concluded that implementation of health system development plan was effective in reducing cesarean section and cesarean section indications. The results of this study are consistent with the present study. Aghaei et al., in a descriptive analytic study in Shiraz in 2015, concluded that the implementation of the health system development plan has led to an increase in the normal delivery rate and reduction of cesarean section in hospitals affiliated to Shiraz University, which is consistent with the findings of this study.

Surani et al (2016) in his cross-sectional descriptive study in Shahrekord concluded that implementation of health system development plan was effective in decreasing cesarean section in the first year of the project. The results of this research are also consistent with our research results.

Piroozi et al (2015) in his retrospective descriptive, longitudinal, and retrospective study, in Kurdistan Province concluded that the plan for the development of the health system to its predetermined goal, namely, a 10% decrease in the rate of cesarean section within a year after the implementation of the development plan relative to the amount was founded.

According to Table 4, there is a significant relationship between reductions of cesarean section after implementation of the development plan at a 5% level. That is, the development plan of the health system has reduced caesarean section in the province. In Table 4, there is a significant relationship between reducing the percentage of cesarean section after the implementation of the health system development plan in the provincial universities. The implementation of the health system reform plan in this province has been able to reduce cesarean section at university centers. And in Table 5, there is no significant relationship between decreasing the percentage of cesarean section after the implementation of the health system development plan in the non-university centers of this province. Despite the fact that implementation of the health system reform plan in this province has been able to reduce first cesarean at non-university centers but because the average three years after the implementation of the plan was taken into account, the total number of hospitals in the first and second year did not drop significantly and declined more in the third year than the independent T-test. This decline is not statistically significant. Educational planning can be useful for empowering physicians and midwives, performing painless and pain-free deliveries, and holding maternity-benefit classes at these centers. Taken together, according to the findings of this research, it can be concluded that the implementation of the health system reform plan (freeing from normal delivery, starting without pain, starting classes for childbirth, empowering and increasing motivation in service providers, protecting privacy and giving credit to pregnant women, and using incentive and hinting methods) is effective in reducing the caesarean rate of this province and it can be hoped that with the continuation of this plan and the full implementation of all related issues, the global standard has essentially reduced mortality and increased maternal and neonatal health.