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Open Access Research article

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

Siamak Aghlmand12*, Feizollah Akbari1, Aboulfath Lameei3, Kazem Mohammad4, Rhonda Small2 and Mohammad Arab1

Author Affiliations

1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran, 1417613191, Iran

2 Mother & Child Health Research, Faculty of Health Sciences, La Trobe University, 324-328 Little Lonsdale Street, Melbourne, Victoria 3000, Australia

3 School of Medicine, Urmia University of Medical Sciences, Jahad Avenue, Urmia 57147, Iran

4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran, 1417613191, Iran

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BMC Pregnancy and Childbirth 2008, 8:20  doi:10.1186/1471-2393-8-20

Published: 13 June 2008



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.


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 evidence-based 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.


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).


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.