 So, this afternoon in Nairobi, and morning in Iran, and the rest of the world, I would like to once again welcome you to this session. My name is Carol Moringa. I'm the facilitator in this session, and I'm based in Nairobi, Kenya. And we will be having our presentation from Fatmeh, who will make a presentation on the effect of prenatal care courses on reducing child birth fear. A review article. Fatmeh is in Iran, and Fatmeh is a midwife. She's a recipient of an MSc in midwifery counseling and a BSC in midwifery, having more than six years of experience as a midwife in primary health centers and hospitals. She currently serves as an instructor at Cuom Medical University, where she trains midwifery students on subjects mainly focused on maternity care. Fatmeh is also an active researcher. She has published several articles in high impact national and international journals, as well as chairing several well-reputed conferences. Fatmeh also works as a research coordinator at Lyle Excellence Center, being very passionate about improving women's health. Fatmeh is currently writing her first book on promoting health and well-being in menopausal women. So Fatmeh, welcome, and you are now the presenter. You can continue from there Fatmeh, welcome. Thank you. Thank you. Thank you, in the department of your university staff. I am also very proud of the day. Thank you. So, all of the panelists are there. Yes, hi, yeah. At the first, I thought we would like to ask you today. Hi, I'm Latke. I have a class 15 COVID-19 program which will help me get a two-year-old of you. Today, I would like to present my reading watch professor, Zee. It is a series of technical analysis, and it's closed at the moment. I'm reviewing a child's access. The third phenomenon is that it is a time-time-used process that is really needed to be used for any initial child's access. It's okay that one of my teachers already got a letter indicating that the child's access is a lot better for all of them. For example, the SNB does not have the chance to access the child's access for the child's access. Yes, it is necessary to keep the test Now there are activities that we need to do in this kind of operation. Next, as you can see, in the four charts are the potential survivors, the silver, the red, and the orange sections. And that happens in all the parts of the world, as you can see. And the percentage of the survivors with the potential survivors of the red section and the integration are totally equal. And in the red U.S. studies, each of us has out of 100 silver-climbing trees. Four-climbing trees has a very high rate of below 10 percent. And for each one of us, we can find trees between head to head, and for each one of us, we can find trees between head to head, and for each one of us, we can find trees between head, and I´m just going to talk about the timing of these trees while we´re talking about this. Do you have my voice right now? Yes, now you´re clearer. Is it better now? Yes, it´s better now. Okay. Please go on, Pat. Okay, but I think my role is not presented because I can change the slides. Am I presented? Yeah, yeah, yeah, thank you. Sorry, sorry to all of you for this interruption and that it happens. Okay, we will continue again. As I said before, in this study that I mentioned the name of this study here in the front of this slide, Iran with 41.9% was recorded as the second country with the highest rate of cesarean section after Brazil. Other studies in Iran showed that more than 70% of cesarean section had no valid reason. 92% of such cases were performed following the request of pregnant women, pregnant women who were scared or concerned about the side effects of natural labor or NVD. For example, Shariat et al. in 2002 and Endrone et al. in 2017 showed that respectively 71% and 80% of mothers choose the cesarean section over the natural childbirth because of Tokophobia. Childbirth or Tokophobia may result from fear of the pain of labor, criminal injury, and newborn death or injury. Fear of childbirth is mainly associated with increased labor pain, proline delivery process, and unpleasant labor experience. This fear could also be due to postpartum deprivation and postpartum anxiety. And also it can increase surgical interventions like CS and negatively delivery outcomes. It is of note that fear of natural childbirth as an unexperienced event is more common in primary parruss women who internalize other women's unpleasant experience and hence incase on performing cesarean section. So, the fear becomes a fact cycle of pressing negatively and leads to increased rate of repeated cesarean section swiftly. Okay, what should we do for these problems? According to articles, educating and preparing pregnant women for normal delivery is a great strategy to decrease the cesarean section rate and fear of NVD. A prenatal peruse education provides a valuable opportunity to improve misconception and misinformation about childbirth, reducing the fear and increasing the self-efficacy of childbirth. Unfortunately, for many years in Iran, the conventional circulars scheduled at the proletar care included only measuring heart, weight, blood pressure, and frontal heart and listening to the fetal heartbeat. Education and consolation programs on labor and better pregnancy control have been inadequate. For this reason, the Health Ministry of Iran has been providing childbirth preparation programs for pregnant women since 2014. The program is called Preparation for Pregnancy Period and Physiological Delivery. Classes assert that twins weak of pregnancy and RA sessions launch and finish at 37th week of pregnancy. Providing relaxation techniques and educating and training methods, such courses aim to relieve pain during labor and reduce the fear and anxiety of mothers. Depressing techniques and muscle and mental relaxation methods are examples of methods in childbirth preparation programs. Present study is a review of articles published by Iranian authors focused on the impact of prenatal care courses on reducing the fear of childbirth and preferred cesarean section. A set of keywords including course of preparation of childbirth, prenatal care course, fear of childbirth, and cesarean section were adopted to select articles published in 2014 when this national program started through training. Away level in PubMed, Google Scholar, Science Diary, Scopus, SID, and Iran Medics databases. In total 385 articles were found and which 12 articles were selected after applying, including and excluding criteria and removing duplicates. And about our results. As you can see in this chart, the increase of cesarean section in country was decreased by 6% immediately after the implementation of the program and it was constant for a long time. Is it possible my friend to be mute? Yes, thank you. During the introduction of the program, as you can see in this chart, was relatively effective in decreasing the rate of cesarean section in Iran. And also, everybody as R in 2016 examined if childbirth preparation courses affected type of delivery. The results show that women's decisions when choosing the type of delivery and the level of anxiety during pregnancy and childbirth differs between case and control with a statistical delivery process. They state that the score of anxiety, the pain of visual pain, acuity in the transition phase, and the pain of visual acuity in the ideal phase and a physiotomy pain were different statistically between the two groups. In contrast, the duration of the labor process, the baby's weight, up-car school, intonation of birth, feeding, and analysis drug use were not different statistically between the two groups. Dear Carol, I'm not present and I couldn't change my slides. Okay, let me get you back on. Sorry about that. I understood you wanted to mute all friends. Let me present. I'm sorry about that. Can you repeat it? No, no, no. Doesn't mention. Thank you. Okay. Results of a study conducted by Rastavariats in 2016 showed a positive effect of course of pregnancy preparation on the duration of labor and reduction of the caesarean section rate. Moreover, the results of a systematic review conducted by Rajabi Naini in 2018 showed that attending courses of childbirth preparation showed a positive effect on postpartum fatigal, depression, and backache resulting from pregnancy. Furthermore, the duration of the active and second phase of labor and mothers' anxiety in the participants was lower in the other group. And around this time in 2017, suppose that the self-efficacy and the rate of normal delivery in the participants were higher than other group. These studies showed that women who showed high self-efficacy experience a lower level of fear and pain and greater childbirth satisfaction. I should mention that factors such as care workers, such as midwife or doctor obstetrics, courses on childbirth preparation, information level of childbirth, relaxation techniques during childbirth and labor. And most importantly, psychological support from family and medical staff had an impact on self-efficacy and the courage of women. These studies until here are in the line with WHO studies, which investigated on 4,000 American women in 1988. The results showed that the use of breast and massage techniques reduced mothers' fear and pain, which in turn reduced the rate of cesarean section and other complications. Their final report included that the leading cause of success is to participate in pregnancy-period courses comprehensively and coherently. On the other hand, Mehrabi SR in 2018 reported that the fear in trained women of the intervention group increased significantly compared to control group. Also, according to Baleri SR study, the post-training score of fear was increased in trained women. They concluded that training score for women in their study area showed an inverse effect, resulting in more fear of women. As a result, a change of concept in a training program was suggested. Wherever Fahimi et al. in 2016 reported that the rate of cesarean section of the group under training was not significantly different from the under-trained group. It was suggested that courses starting time, little use of appropriate training and relaxation techniques, and different communities' culture may be explained or observed in consistency. I should mention that a literature review in 2020 reported that only 30% of Iranian pregnant women participated in this national program. Their lack of knowledge and access is one of the main reasons withholding them from training participation. This program has been running for about seven years, but unfortunately only in some of Iran's major cities. As a conclusion, I should say to decrease the rate of cesarean section and the fear of natural drivers or NVIDIA, we need a long-term program to improve the negative attitude towards NVIDIA. Such programs should be complete and comprehensive, available for pregnant women and also care workers who deal with NVIDIA. And also implementation painless delivery techniques, complementary medicines such as aromatherapy, dried birds at home, or in water are among the metals that lead success in most countries. And we hope that an adequate number of health centers are provided so that physiological delivery services are also accessible for pregnant women in small villages and towns. We also advise on further research on developing new childbirth control metals such as hypnosis, or ecotropy, and acupressure and massage. And also mid-vibes counselors play an influential role in reducing fear and anxiety and changing the inappropriate culture of elective cesarean section. It is anticipated that a combination of mid-vibes-free knowledge and consolating techniques, a skills offered by mid-vibes counselors can considerably identify, manage, and terminate tachophobia. And this is my differences that I've used in this article. In the last part, I would like to say thank you, thank you, thank you for your attention. I hope it was useful for you. Thank you to all my facilitators and also I would like here to send to VIDM for holding this webinar. I do hope this webinar will start for international cooperation in research and education. I hope that after this meeting we will see more international collaboration in mid-vibes-free. Thank you. I'm ready for answering your question if you have. And if you don't have any questions, I invite you to have a conversation. And kindly I would like to know your ideas and your solution about this question. What is your solution to improve the negative attitude towards everybody? And also what should we do for the decrease the rate of cesarean section? Thank you. Thank you very much Fatmeh. That was a great presentation. We really appreciate it. Kindly mute. Please mute. There are a few questions, comments. Actually it's more of comments. People are really celebrating you. I can see some of your colleagues saying there will be a celebration after this. But there's a question here that says, as student in the chat box, a student midwife thought how to encourage any oxydoxin rich environment to facilitate normal birth, upright positions, low lights, private environments. And you can also see there's another one here. Can you speak more about the type of education and how this contributed to the finding of increasing fear among the expected families? We have just exactly three minutes for the presentation. But again, the comments are really awesome. Well done Fatmeh. Great presentation. Yeah. So maybe you can take in a quick two questions and then we can end this session. Fatmeh, can you hear me? Fatmeh? Thank you dear Karol. Yeah, I want to find a question that Frances said. There's a question here from Rene who says, can you speak more about the type of education? There is another one that says, did you feel free? Did you feel women accepted the classes or did you experience with them? Yeah. In my presentation, we invited all pregnant women when they received in the 20th week of their pregnancy. And they have eight educational classes that we talked about all details about pregnancy, different kinds of delivery, and also about breastfeeding and how they can manage their babies after their childbirth. And also, we invited their husbands in this session. Instead of education, we also have some exercises and also yoga, they training with a coach and they will be ready for their childbirth. And then they follow by a doula in the last month and weeks of their pregnancy and with a special doula. But they were in two delivery parts and they are passing their all labors. And yes, we tried to have a specialized and also a unique pregnancy educational for them. But unfortunately, as I said in my presentation, these classes presented or applying just in some health centers and some of them, they are private and they are not accessible for all people in different kinds of income. Fatmeh, thank you very much for responding to those sessions. Encouraging each one of us here, maybe you can reach out to Fatmeh. Offline after this, she shared her email address. You can get in touch with her, but I really, really do appreciate for your time. You have been very, very great audience. She has posted her email address there, her details are there online. I think I did reach out and let's keep this discussion going.