Identifying Strategies for Implementing Woman-Centered Care in Iranian Maternity Services: A Modified Delphi Study

At the heart of the midwifery profession lies the profoundly valuable philosophy of woman-centered care. Given the high rate of unnecessary interventions and women's limited access to optimal health services in Iranian maternity care, a locally-developed strategy is essential to promote woman-centered care. The current study aimed to provide strategies to improve and promote woman-centered care in the provision of maternity services.

This study is part of a mixed-methods research with a sequential explanatory design, conducted in two rounds using a modified Delphi technique. This study was conducted from July to September 2023 in Tabriz, Iran. The strategies were designed by incorporating the results of the quantitative and qualitative phases of the mixed-methods study, along with a literature review and feedback received from the experts. This study involved 13 experts with Ph.D. degrees in Midwifery or Reproductive Health, drawn from the faculty members of various educational and research institutions across different cities in Iran (Tehran, Tabriz, Alborz, Ahvaz, Urmia, Ardabil, and Babol). Consensus was defined as ≥70% agreement on a 5-point Likert scale in the second round.

The strategies included 89 statements, which were divided into seven categories: 1) ethical values, 2) professional competence, 3) occupational and regulatory laws 4) education of women and midwives, 5) labor, pregnancy, and childbirth 6) policy-making and implementation, and 7) social recommendations. All 89 recommendations (100%) achieved the predefined consensus threshold of ≥70%. Based on consensus levels, recommendations were classified into two implementation tiers: Core recommendations (Priority 1) with 100% consensus (n=62) recommended for immediate implementation, and Optional recommendations (Priority 2) with 92.30% to 76.92% consensus (n=27) suitable for phased implementation.

The findings of the current study provided clear principles and standards regarding strategies for improving and promoting woman-centered care in health centers and hospitals by Iranian midwives. These recommendations serve as a self-assessment tool for midwives, a framework for curriculum revision, a roadmap for administrators to optimize staffing, and clear policy directions for budget allocation, midwife-led care models, and reducing out-of-pocket expenses. Future research should evaluate implementation feasibility across diverse settings and include perspectives from all maternity care stakeholders.