Abstract

BACKGROUND Normal birth is still highly valued, but the majority of pregnancies end with medical interventions or caesarean section. Rates of normal birth have been declining steadily over the past 20 years in Iran, despite the evidence of the benefits to mother and baby. According to the World Health Organization, the standard rate for caesarean is 10-15. In 2013, Iran Ministry of Health introduced the "Promoting Normal Birth Program". This study examines the views of experts about factors affecting the implementation of "Promoting Normal Birth Program". METHODS A qualitative study with framework analysis was used to determine the factors affecting implementation of the "Promoting Normal Birth Program" by examining views of 15 gynaecologists, anaesthesiologists, midwives and managers in 2018 at Zabol Medical Sciences University. Professionals participated with informed consent in this study. Data was collected from individual and group semi-structured interviews to reach saturation. MAXQDA 12 was used for analysis. RESULTS Seven categories were identified: (1) Leadership of Ministry, (2) Education, (3) Create Culture for a Normal Birth, (4) Optimization and Pleasure of Birth, (5) Normalization: The Essence of Birth and Midwifery, (6) Support, and (7) Empowerment. CONCLUSIONS These findings create a challenge for education, performance and health policies. In order to achieve program goals and improve women's health, the following actions are recommended- provide adequate infrastructure and financing to improve the birth environment, increase midwifery force, and promoting the culture of Normal birth, especially through the education for community, women, and caregivers, correcting rules and guidelines and detailing job descriptions and professional status.