Rebirth of the Meaning of Natural Childbirth: A Qualitative Study on the Perceived Impacts of Effective Midwife–Mother Communication among Iranian Midwives and Mothers
Abstract
Background: Although effective communication between midwives and mothers is linked to positive physiological and emotional outcomes, research on this topic within maternity wards remains limited, and both perspectives have not been adequately explored. A comprehensive understanding of these perceived impacts is essential to highlight the importance of communication in maternity care. This study aims to explore the perceived impacts of effective midwife–mother communication in the maternity ward. Materials and Methods: A qualitative approach was adopted to explore perceptions of effective midwife–mother communication using the conventional content analysis method. Semi‑structured interviews were conducted between July and October 2023 with 11 midwives and 12 postpartum mothers in the maternity wards of Ahvaz, Iran. Participants consisted of midwives working in maternity units and mothers who had experienced vaginal births, selected through purposive sampling. Data were analyzed using a thematic analysis approach. Results: Thematic analysis revealed one central theme: the rebirth of the meaning of natural childbirth, supported by three themes: 1) reshaping mothers’ beliefs and attitudes toward childbearing, 2) meaning‑making in natural childbirth, and 3) improving the quality of midwifery services. Conclusions: Effective communication between midwives and mothers can help restore values and positive emotions and redefine the meaning and experience of natural childbirth. It is recommended that comprehensive frameworks or guidelines for effective communication be developed and integrated into midwifery curricula, training programs, and clinical interventions. Future studies should focus on communication processes and barriers across different maternity care settings to identify effective practices and areas for improvement.
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Kassa ZY, Dadi AF, Bizuayehu HM, Hassen TA, Ahmed KY, Ketema DB, et al. Person-centred maternity care during childbirth: A systematic review in low and middle-income countries. BMC Pregnancy Childbirth 2025;25:147.
Ratna H. The importance of effective communication in healthcare practice. Harv Public Health Rev 2019;23:1-6.
Bradford BF, Wilson AN, Portela A, McConville F, Fernandez Turienzo C, Homer CS. Midwifery continuity of care: A scoping review of where, how, by whom and for whom? PLOS Glob Public Health 2022;2:e0000935.
Eri TS, Berg M, Dahl B, Gottfreðsdóttir H, Sommerseth E, Prinds C. Models for midwifery care: A mapping review. Eur J Midwifery 2020;4:30.
Olza I, Leahy-Warren P, Benyamini Y, Kazmierczak M, Karlsdottir SI, Spyridou A, et al. Women’s psychological experiences of physiological childbirth: A meta-synthesis. BMJ Open 2018;8:e020347.
Kuipers YJ, Thomson G, Goberna-Tricas J, Zurera A, Hresanová E, Temesgenová N, et al. The social conception of space of birth narrated by women with negative and traumatic birth experiences. Women Birth 2023;36:e78-85.
Akbaş P, Özkan Şat S, Yaman Sözbir Ş. The effect of holistic birth support strategies on coping with labor pain, birth satisfaction, and fear of childbirth: A randomized, triple-blind, controlled trial. Clin Nurs Res 2022;31:1352-61.
Leinweber J, Fontein‐Kuipers Y, Karlsdottir SI, Ekström‐Bergström A, Nilsson C, Stramrood C, et al. Developing a woman‐centered, inclusive definition of positive childbirth experiences: A discussion paper. Birth 2023;50:362-83.
Findlay HJ, Anderson JK, Francis KL, Clegg LM, Maria SJ. The significance of paramedic communication during women’s birth experiences: A scoping review. Australas Emerg Care 2024;27:218-26.
Agbi FA, Lulin Z, Asamoah EO. Quality of communication between healthcare providers and pregnant women: impact on maternal satisfaction, health outcomes, and shared decision-making. UJOG 2023;2:3-10.
Doering K, McAra-Couper J, Gilkison A. Seeking a connection: Women’s lived experience of the woman–midwife relationship in mainstream maternity services in Japan. Women Birth 2023;36:e598-604.
Smorti M, Ponti L, Tani F. The effect of maternal depression and anxiety on labour and the well-being of the newborn. J Obstet Gynaecol 2019;39:492-7.
Jenabi E, Khazaei S, Bashirian S, Aghababaei S, Matinnia N. Reasons for elective cesarean section on maternal request: A systematic review. J Matern Fetal Neonatal Med 2020;33:3867-72.
Rao A, Srinidhi V, Karachiwala B, Santosh S, Seshadri SR, Thomas S, et al. How power and knowledge hierarchies affect communication in intrapartum care: Findings from public health facilities in two southern Indian districts. BMC Pregnancy Childbirth 2024;24:781.
World Health Organization (WHO). WHO recommendations on intrapartum care for a positive childbirth experience. Geneva: World Health Organization (WHO); 2018.
Cayama MR, Vamos CA, Harris NL, Logan RG, Howard A, Daley EM. Respectful maternity care in the United States: A scoping review of the research and birthing people’s experiences. J Midwifery Womens Health 2025;70:212-22.
Gebeyehu NA, Adella GA, Tegegne KD. Disrespect and abuse of women during childbirth at health facilities in Eastern Africa: Systematic review and meta-analysis. Front Med 2023;10:1117116.
Khalil M, Carasso KB, Kabakian-Khasholian T. Exposing obstetric violence in the eastern Mediterranean region: A review of Women’s narratives of disrespect and abuse in childbirth. Front Glob Womens Health 2022;3:850796.
Guðmundsdóttir EÝ, Nieuwenhuijze M, Rúdólfsdóttir AG, Gottfreðsdóttir H. Fostering empowerment through communication: The needs, expectations, and experience of maternity care among polish migrant women in Iceland. Sex Reprod Healthc 2025;44:101087.
Withanarachchie V, Todd V, Dicker B, Maessen SE. Navigating emotions, communication, and pain during prehospital labour: A mixed-methods survey with emergency ambulance services. BMC Emerg Med 2025;25:83.
Jacques M, Chantry AA, Evrard A, Lelong N, Le Ray C, Group ES, et al. Frequency and determinants of words, gestures, and attitudes experienced as disrespectful during childbirth and postpartum: A national population‐based study. Acta Obstet Gynecol Scand 2025;104:1056-69.
Suarez A, Yakupova V. Past traumatic life events, postpartum PTSD, and the role of labor support. Int J Environ Res Public Health 2023;20:6048.
Brilhante AVM, Branco JGO, Colares MSF, Sampaio LADM. Communication in maternal near miss cases: An analysis based on Habermas. Cien Saude Colet 2024;29:e08582023.
Hajizadeh K, Vaezi M, Meedya S, Mohammad Alizadeh Charandabi S, Mirghafourvand M. Prevalence and predictors of perceived disrespectful maternity care in postpartum Iranian women: A cross-sectional study. BMC Pregnancy Childbirth 2020;20:1-10.
Dolatabadi Z, Farahani LA, Zargar Z, Haghani S, Mousavi SS. Disrespect and abuse during childbirth and associated factors among women: A cross-sectional study. BMC Pregnancy Childbirth 2025;25:229.
Moridi M, Pazandeh F, Potrata B. Midwives’ knowledge and practice of Respectful Maternity Care: A survey from Iran. BMC Pregnancy Childbirth 2022;22:752.
Pazandeh F, Moridi M, Safari K. Labouring women perspectives on mistreatment during childbirth: A qualitative study. Nurs Ethics 2023;30:513-25.
Shirzad M, Shakibazadeh E, Hajimiri K, Betran AP, Jahanfar S, Bohren MA, et al. Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in Iran: A mixed-methods systematic review. Reprod Health 2021;18:1-30.
Yeganeh Z, Javadnoori M, Abbaspoor Z, Ebadi A, Montazeri S. “Inspiring mothers’ self-entrustment to midwives.” midwives’ and mothers’ perceptions of effective communication in the maternity ward: A qualitative study. BMC Pregnancy Childbirth 2025;25:962.
Clarke V, Braun V. Thematic analysis. J Posit Psychol 2017;12:297-8.
Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Eval 1986;1986:73-84.
Kananikandeh S, Amin Shokravi F, Mirghafourvand M, Jahanfar S. Factors of the childbirth fear among nulliparous women in Iran. BMC Pregnancy Childbirth 2022;22:547.
Rafiei M, Ghare MS, Akbari M, Kiani F, Sayehmiri F, Sayehmiri K, et al. Prevalence, causes, and complications of cesarean delivery in Iran: A systematic review and meta-analysis. Int J Reprod BioMed 2018;16:221.
Dixon L, Daellenbach S, Anderson J, Neely E, Nisa-Waller A, Lockwood S. Building positive respectful midwifery relationships: An analysis of women’s experiences of continuity of midwifery care in Aotearoa New Zealand. Women Birth 2023;36:e669-75.
Perrotte V, Chaudhary A, Goodman A. “At least your baby is healthy” obstetric violence or disrespect and abuse in childbirth occurrence worldwide: A literature review. Open J Obstet Gynecol 2020;10:1544.
Preis H, Tovim S, Mor P, Grisaru-Granovsky S, Samueloff A, Benyamini Y. Fertility intentions and the way they change following birth-a prospective longitudinal study. BMC Pregnancy Childbirth 2020;20:1-11.
Alijanzadeh M, Bahrami N, Jafari E, Noori M, Miri F, Joftyar M, et al. Iranian women’s attitude toward childbearing and its’ association with generalized trust, social support, marital satisfaction and governmental childbearing incentives. Heliyon 2023;9:e16162.
Downe S, Finlayson K, Oladapo O, Bonet M, Gülmezoglu AM. What matters to women during childbirth: A systematic qualitative review. PLoS One 2018;13:e0194906.
Rocca‐Ihenacho L, Yuill C, McCourt C. Relationships and trust: Two key pillars of a well‐functioning freestanding midwifery unit. Birth 2021;48:104-13.
Ojo A, Rizun N, Walsh GS, Przychodzen W, Mashinchi MI, Foley C, et al. Building confidence and trust in Ireland’s National Maternity Services Workforce–What matters most and how? Health Policy 2023;138:104947.
Sripad P, Ozawa S, Merritt MW, Jennings L, Kerrigan D, Ndwiga C, et al. Exploring meaning and types of trust in maternity care in peri-urban Kenya: A qualitative cross-perspective analysis. Qual Health Res 2018;28:305-20.
Hosseini Tabaghdehi M, Keramat A, Kolahdozan S, Shahhosseini Z, Moosazadeh M, Motaghi Z. Positive childbirth experience: A qualitative study. Nurs Open 2020;7:1233-8.
Malatji R, Madiba S. Disrespect and abuse experienced by women during childbirth in midwife-led obstetric units in Tshwane District, South Africa: A qualitative study. Int J Environ Res Public Health 2020;17:3667.
Sripad P, Merritt MW, Kerrigan D, Abuya T, Ndwiga C, Warren CE. Determining a trusting environment for maternity care: A framework based on perspectives of women, communities, service providers, and managers in peri-urban Kenya. Front Glob Womens Health 2022;3:818062.
Khullar D. Building trust in health care—Why, where, and how. JAMA 2019;322:507-9.
Sadeghi Bazargani H, Saadati M, Tabrizi JS, Farahbakhsh M, Golestani M. Forty years after Alma-Ata: How people trust primary health care? BMC Public Health 2020;20:1-6.
Teshnizi SH, Aghamolaei T, Kahnouji K, Teshnizi SMH, Ghani J. Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis. Int J Qual Health Care 2018;30:82-9.
Hashemzadeh M, Shariati M, Mohammad Nazari A, Keramat A. Childbearing intention and its associated factors: A systematic review. Nurs Open 2021;8:2354-68.
Zeng T, Yuan M, Wu M, Chen Y, Zhang K. Why do pregnant women with fear of birth prefer vaginal birth? A qualitative study in China. Front Psychol 2023;14:1110116.
Sobczak A, Taylor L, Solomon S, Ho J, Kemper S, Phillips B, et al. The effect of doulas on maternal and birth outcomes: A scoping review. Cureus 2023;15:e39451. Erratum in: Cureus 2025;17:c310.
Mehri N, Messkoub M, Kunkel S. Trends, determinants and the implications of population aging in Iran. Ageing Int 2020;45:327-43.
Hunter M, Smythe E, Spence D. Confidence: Fundamental to midwives providing labour care in freestanding midwifery-led units. Midwifery 2018;66:176-81.
Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S, et al. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev 2024;4:CD004667.
Doherty J, Coughlan B, Lynch S, Sheehy L, Martin CH, Martin C, et al. The importance of communication and involvement in decision-making: A study in Ireland exploring birth satisfaction using the Birth Satisfaction Scale-Revised (BSS-R). Eur J Midwifery 2023;7:12.
Lazzerini M, Mariani I, Semenzato C, Valente EP. Association between maternal satisfaction and other indicators of quality of care at childbirth: A cross-sectional study based on the WHO standards. BMJ Open 2020;10:e037063.
Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, et al. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Health 2024;12:e306-16.
Rayment-Jones H, Silverio SA, Harris J, Harden A, Sandall J. Project 20: Midwives’ insight into continuity of care models for women with social risk factors: What works, for whom, in what circumstances, and how. Midwifery 2020;84:102654.
McInnes RJ, Aitken-Arbuckle A, Lake S, Hollins Martin C, MacArthur J. Implementing continuity of midwife carer–just a friendly face? A realist evaluation. BMC Health Serv Res 2020;20:1-15.
Zondag DC, van Haaren-Ten Haken TM, Offerhaus PM, Maas VY, Nieuwenhuijze MJ. Knowledge and skills used for clinical decision-making on childbirth interventions: A qualitative study among midwives in the Netherlands. Eur J Midwifery 2022;6:56.
Sabetghadam S, Keramat A, Goli S, Malary M, Chamani SR. Assessment of medicalization of pregnancy and childbirth in low-risk pregnancies: A cross-sectional study. Int J Community Based Nurs Midwifery 2022;10:64-73.
Bączek G, Tataj-Puzyna U, Sys D, Baranowska B. Freestanding midwife-led units: A narrative review. Iran J Nurs Midwifery Res 2020;25:181-8.
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