Developing evidence-based maternity care in Iran: A quality improvement study

Current Iranian perinatal statistics indicate that maternity care continues to need
improvement. In response, we implemented a multi-faceted intervention to improve the quality of
maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was
to improve the uptake of selected evidence based practices and more closely attend to identified
women's needs and preferences.
Methods: The major steps of the study were to (1) identify women's needs, values and
preferences via interviews, (2) select through a process of professional consensus the top evidencebased
clinical recommendations requiring local implementation (3) redesign care based on the
selected evidence-based recommendations and women's views, and (4) implement the new care
model. We measured the impact of the new care model on maternal satisfaction and caesarean
birth rates utilising maternal surveys and medical record audit before and after implementation of
the new care model.
Results: Twenty women's needs and requirements as well as ten evidence-based clinical
recommendations were selected as a basis for improving care. Following the introduction of the
new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p < 0.0001)
compared with baseline. Seventy-eight percent of studied women experienced care consistent with
the new model and fewer women had a caesarean birth (30% compared with 42% previously).
Conclusion: The introduction of a quality improvement care model improved compliance with
evidence-based guidelines and was associated with an improvement in women's satisfaction levels
and a reduction in rates of caesarean birth.