Background Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran. Methods This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist. Results In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor). Conclusions This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops.

BACKGROUND:Pictorial education could provide an innovative approach for health educators which help to increase health-related information, the attention of individuals, comprehension, and recall.AIM:The purpose of this study was to determine the effect of pictorial perception of labour process by persuading Iranian women toward normal vaginal delivery.MATERIALS AND METHODS:The pre and post non-randomized trial with control group carried out on non-probability sample consisted of 76 pregnant women during the third trimester of pregnancy in the four urban health care centres in Pars-Abad city, Iran, during 2014. Demographic, knowledge, attitude, subjective norms, outcome expectations, self-efficacy, and intention to do normal vaginal delivery variables were measured by using self-administered questionnaire and via the self-report method. Data analysis was performed using SPSS-21 software by Independent t-test, repeated measure, paired T-test, ANOVA, chi-square, Cochran’s Q, and McNemar test. Manipulation included a pictorial education program to persuade pregnant women toward selecting normal vaginal delivery.RESULTS:The results showed significant improvement in mean scores of knowledge, attitudes, self-efficacy and behavioural intention of labour after manipulation in the intervention group (P < 0.001). It was found about 60% changes for intending to choose normal vaginal delivery, and 27/06% of women in the intervention group reported normal vaginal delivery versus the control group. And 10/81% of women did a cesarean section because of medical reasons during of delivery. Reduction of cesarean section was evident. Additionally, the annual rate of cesarean section decreased about 7% in comparison to the previous year.CONCLUSION:Pictorial education could be effective on the intention of women to choose natural vaginal delivery among pregnant women, and it can be used as an effective training technique for developing health literacy, enhancing self-efficacy and decision-making power of women in the delivery.

Aim Designing, executing and testing a training intervention based on enhanced concepts of salutogenesis theory for managing fear of childbirth and choice of delivery method among nulliparous women. Design A Sequential‐Exploratory Mixed Methods Research. Methods In the first phase (qualitative approach), the determinants of childbirth fear among nulliparous women will be explored. In the second phase (systematic review), the factors of childbirth fear among them will be summarized. In the third phase, the content of the educational intervention is developed based on the common factors of childbirth fear obtained from the previous two phases of the study. In the fourth phase (randomized controlled trial), two intervention and the control groups will be compared based on primary and secondary outcomes. Discussion Using salutogenesis theory in a few interventional studies on various health areas has produced promising results. Based on the evidence, women had less sense of coherence with a strong childbirth fear. Therefore, developing an effective intervention based on this theory can probably help manage childbirth fear and reduce the costs of any potential consequences.

Background: Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran.Methods: This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist.Results: In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor). Conclusions: This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops.

Background and Purpose: Violence against reproductive age women harms other health prioritiesو such as family planning and maternal health. This study aimed to identify the determinants of violence among reproductive age women. Materials and Methods: This cross-sectional study was conducted among 182 married women, 15-49 years old in Sarab City, Iran, through simple random sampling in 2018. Data were collected by a self-designed questionnaire including demographic characteristics, physical, psychological, verbal, economic, and sexual violence. Then, it was analyzed using an independent samples t-test, one-way ANOVA, Pearson Correlation, and multivariate linear regression. Results: The prevalence of physical, psychological, sexual, economic and verbal violence in women was 11(6%), 14(7.7%), 18(9.9%), 24(13.2%), and 37(20.3%), respectively. Husband's older age and husband's older age of marriage increased (B= 0.14, 95% CI= 0.00 to 0.28) and decreased (B= -1.17, CI=-0.27 to -0.06) verbal violence against women. Illiteracy in spouses reduced physical violence (B=-2.43, CI= -4.58 to -0.27) and sexual violence (B= -1.62, CI= -3.08 to -0.16) and in women, it reduced psychological violence (B= -2.63, CI= -4.81 to -0.45). Spousal smoking reduced physical  (B= -0.97, CI= -1.78 to -0.17), psychological (B= -1.17, CI= -2.01 to -0.33), and verbal (B= -1.22,  CI= - 1.96 to -0.48) violence; however, women's alcoholism (B= 7.31, CI= 0.27 to 4.43) and having children from a previous marriage of the woman (B= 0.06, CI= 0.04 to 1.16) increased physical violence. The highest economic violence was seen in female employees (B= 1.31, CI= 0.35 to 2.27). Psychological  (B= -4.92, CI= -7.89 to -1.49) and sexual (B= -2.16, CI= - 4.09 to -0.22) violence was less experienced in men's second marriage. Conclusion: Considering the high prevalence of verbal violence and related factors, conducting the necessary screenings to recognize it in time, teaching communication skills and anger management to husbands seems essential.