ArticleReproductive health2026
Updating the Iranian National Childbirth Preparation Classes guideline: a multi-phase mixed-methods protocol study.
Article in Reproductive health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChildbirth Preparation Classes (CPCs) have been implemented nationally in Iran for more than two decades to promote maternal empowerment and physiological childbirth. However, cesarean section rates remain high, participation in CPCs is low, and previous evaluations have reported inconsistent psychological and obstetric outcomes. The absence of systematic, evidence‑based updates to the national CPC guideline has raised concerns regarding its relevance, content validity, and alignment with contemporary maternal health priorities. Therefore, this study describes a methodological protocol for updating, validating, and field testing the national CPC guideline using evidence‑based and context‑specific framework.
methodsThis multi‑phase mixed‑methods protocol follows the SPIRIT 2013 recommendations. Four sequential phases are planned: (1) a systematic review and meta‑analysis of national and international literature to identify evidence‑based components of effective childbirth education programs; (2) a qualitative needs assessment through in‑depth interviews with experienced CPC instructors and key stakeholders to explore contextual gaps and implementation barriers; (3) a quantitative descriptive‑analytical study to describe current CPC participation patterns and maternal health indicators; and (4) a cluster‑randomized feasibility and acceptability study to evaluate the practical implementation of the updated guideline within public health centers. The revised CPC guideline will retain the original eight‑session structure and will undergo structured, multi‑stage expert validation and consensus review by academic specialists and health system authorities. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Ethics Committee of Mashhad University of Medical Sciences, and the interventional component is registered in the Iranian Registry of Clinical Trials (IRCT20240709062375N1). Findings will be disseminated through peer‑reviewed publications, conference presentations, and policy briefs to inform national maternal education planning.
trial registrationIranian Registry of Clinical Trials: IRCT20240709062375N1.
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