Iranian mothers' selection of a birth method in the context of perceived norms: A content analysis study Zahra Abbaspoor, MSc in Midwifery (PhD Student of Reproductive Health) a , Lida Moghaddam-Banaem, MD, PhD in Maternal & Child Health (Assistant Professor) a,n , Fazlollah Ahmadi, PhD in Nursing (Professor) b a Department of Midwifery and Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran b Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran article info Article history: Received 27 March 2013 Received in revised form 4 May 2013 Accepted 11 June 2013 Keywords: Caesarean section Maternal request Socio-cultural norms Iranian women abstract Objective: to describe women's perceptions of choosing a particular birth method; normal childbirth or caesarean section in the absence of medical indications. Design: a descriptive qualitative content analysis was used for data gathering and analysis. Interviews were held with 18 pregnant and postnatal women. The participants were recruited using a purposive sampling method. Interviews were begun with a general question and were followed with specific questions. Setting: three semi-public and public hospitals and two health care centres in an urban area of Iran were the locations of data gathering. Data analysis and data collection were conducted concurrently and interviews were discontinued when data saturation was reached. Participants: the participants consisted of 18 women (four pregnant and 14 postnatal) recruited using a purposive sampling method. Findings: ‘socio-economic and cultural norms’ was the main theme that emerged in this study. Four other categories comprised the content of interviews: ‘cultural and religious acceptance’, ‘social acceptance’, ‘psychological–social support’, and ‘economical acceptance’. Conclusions and implications: socio-cultural, religious and economical norms in the Iranian society play main roles in the selection of the birth method by Iranian women. Health care policy-makers are expected to attend to the factors influencing women's decision-making on the childbirth method to reduce the number of unnecessary caesarean sections. & 2013 Elsevier Ltd. All rights reserved. Introduction In recent decades, cultural and practical understanding of childbirth is changing, which has resulted in higher rates of caesarean section (CS) and lower rates of normal vaginal delivery (NVD) (Notzon et al., 1987; Van Roosmalen and Van der Does, 1995; Kerr-Wilson, 2001). The rate of CS is increasing in both developed and developing countries. In a study by the World Health Organization (WHO) in 2007–2008 in 24 countries, the average rate of CS was 27% (Lumbiganon et al., 2010). According to this report, in China this rate was the highest (46.2%) (Hamilton et al., 2007; Souza et al., 2010). It has been reported that in 2007 in the U.S. nearly 32% of all births (1.4 millions) have been the result of CS (Menacker and Hamilton, 2010). In Iran, several studies have shown that the increasing rate of CS is higher than the rate (10– 15%) recommended by the WHO (Sharifi Rad et al., 2007; Shahoei et al., 2011; Yazdizadeh et al., 2011). For instance, in 2002 in Tehran, the total rate of CS was reported to be 66.5%, rising to as high as 84% for childbirths in private centres (Sharyat et al., 2002). In Ahvaz, another large city of Iran, the rate of CS in 2010 was 41.3% in teaching hospitals and 58.8% in private hospitals (Iran Ministry of Health and Medical Education (IMHME), 2010). One of the main causes for such rising rates in Iran and other countries is the phenomenon of ‘caesarean by request’ (Guise et al., 2005; Hajian et al., 2011). According to international estimates, the range of maternal request is from 4% to 18% of all caesarean sections (National Institute of Health, 2006). In Iran this rate varies between 7% and 13.5% (Rahmanian and Qosorry, 2011). Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.midw.2013.06.003 n Corresponding author. E-mail addresses: Z.abbaspoor@modares.ac.ir (Z. Abbaspoor), moghaddamb@modares.ac.ir (L. Moghaddam-Banaem), ahmadif@modares.ac.ir, Ahmadi_Fazl@hotmail.com (F. Ahmadi). Please cite this article as: Abbaspoor, Z., et al., Iranian mothers' selection of a birth method in the context of perceived norms: A content analysis study. Midwifery (2013), http://dx.doi.org/10.1016/j.midw.2013.06.003i Midwifery ∎ (∎∎∎∎) ∎∎∎–∎∎∎