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Objectives: Childbearing is considered as a great event in the lives of many women while the effect of pain on this event is undeniable. Thus, the think of pain and how to overcome it has engaged the minds of women, their family, and health-care providers. The birth ball is one of the non-invasive methods of pain control. Therefore, the present study aimed to evaluate the effect of the birth ball on the pain and self-efficacy of pregnant women during the childbirth process. Materials and Methods: This study was a randomized clinical trial. A total of 178 participants were selected based on the specific selection criteria and randomly allocated to control and intervention groups. The women in the intervention group were asked to join a planned exercise with the birth ball including a 20-minute well-defined exercise three times a week for 6–8 weeks at home whereas those in the control group followed up the routine prenatal cares. The questionnaires were completed by the participants at the four and eight-centimeter cervical dilations. Results: Based on the results, birth ball exercises could significantly improve childbirth self-efficacy and pain so that labour pain was lower in this group of women as compared to the other group (P<0.001 in both cervical dilatations). In addition, the score of selfefficacy was higher in the intervention group compared to the control group (P<0.001). Further, the result of generalized estimating equation model showed that birth ball exercise can decrease the childbirth pain. However, part of this effect may be related to an increase in the patients’ self-efficacy (30%-40%). Conclusions: In general, although birth ball exercise could decrease the childbirth pain, part of this effect was probably associated with an increase in self-efficacy of the patients.

Background Current study was conducted with the aim of explaining domains of clinical competence in undergraduate midwifery students so that it addresses the challenges in midwifery curriculum and improving clinical assessment methods in Iranian undergraduate midwifery students. Methods Qualitative approach and conventional content analysis were used in the design of the present study. The research setting included midwifery and nursing schools and hospitals and health centers affiliated to Tehran and Guilan universities of medical sciences in Iran. The target population consisted of undergraduate midwifery students in the fourth to eighth semesters of school, midwives working in hospitals and health centers, midwifery faculty members, and obstetricians. The participants were selected through purposive maximum variation sampling, which continued until data saturation. After in-depth semi-structured interviews, the content of the interviews was analyzed according to the steps proposed by Zhang & Wildemuth. Results Twenty-four people participated in this study, including seven midwifery students, seven midwives, nine midwifery and reproductive and sexual health faculty members, and one obstetrician. The participants were aged 20–56 years and their mean age was 39.75 years. Their level of education varied from midwifery student to PhD. The mean work experience of the participants was 13.62 years and the mean duration of the interviews was 48 min. The analysis of the data obtained from the experiences of the participants led to the formation of the four categories of ethical and professional function in midwifery, holistic midwifery care, effective interaction, and personal and professional development, along with ten subcategories. Conclusion The findings of the present study showed that clinical competence in midwifery students involves different domains that correspond well overall to the general definitions of clinical competence in different sources. These findings can be used as a basis for the design and psychometric assessment of a clinical competence assessment tool for undergraduate midwifery students.