Comparing the Experiences of Birth Experiences Women With Remifentanil Analgesia and Elective Cesarean Section and Providing Improver Strategies: A Sequential Explanatory Mixed Method Study
Authors: dousti rana , Hakimi sevil , Pourfathi Hojjat , Nourizadeh Roghayeh , Jahdi Niloufar Sattarzadeh 
Published: December 2020

Abstract
BackgroundIdentifying methods that are effective and safe while also compatible with maternal needs and improving the delivery experience is important. Since pharmacological interventions provide better pain alleviation for women during labor when compared to nonpharmacological interventions, in case the former also improves women satisfaction with the labor experience, care providers can propose this method for mitigating the women's pain during labor. The aim of this study is to compare the experience of parturient women between remifentanil analgesia and elective C-section, as well as proposing ameliorating strategies in Tabriz city, Iran.MethodThe present research is of mixed methods research type with a sequential explanatory approach. The first stage is quantitative and longitudinal. The target population consists of parturient women receiving elective C-section and vaginal labor through remifentanil analgesia in the private hospitals of Tabriz city. The sampling will be performed from all private hospitals of Tabriz city as available sampling. They will be chosen from each hospital based on specific rations in relation to the eligible women according to the inclusion criteria, and then assigned into two groups (elective C-section and parturient women receiving remifentanil). Demographic characteristics as well as Edinburgh's depression test during pregnancy questionnaires plus labor agentry scale (LAS) as well as the checklist of maternal and neonatal outcomes within 24 hours postdelivery will be completed by the researcher. The subjects will be followed up for up to 30 days postdelivery in order to complete the Edinburgh depression questionnaire. The second stage of study is qualitative performed to interpret parturient women's perception about elective C-section and Remifentanil anesthesia regarding different aspects and the factors associated with delivery experience. The sampling will continue until data saturation, i.e. no new information or code is received. Based on the results of the total mean score of delivery experience, which will be obtained in the quantitative section, the extreme cases will be chosen. For this purpose, at both ends of the total score spectrum of the delivery experience, the women acquiring the 10% upper and lower extreme total score of delivery experience will be chosen as the extreme cases. Purposeful sampling will be done on mothers belonging to extreme cases and who are willing as well as able to express their experiences. In the third stage, in order to provide ameliorating strategies for delivery experience, after combining the quantitative and qualitative studies, a review of the literature and then nominal group technique will be used.DiscussionBy comparing the experience of parturient women receiving Remifentanil analgesia and elective C-section, evidence-based improving strategies using a culturally sensitive approach can be provided. Presentation of the results obtained from this study using the mixed method may help in better understanding the issue. Also, the obtained results can be used to enhance the quality of midwifery care to be examined by health policymakers and planners.Ethical codeIR.TBZMED.REC.1399. 521